For each of your patients in Therabill, you have the ability to indicate whether or not you Accept Assignment. This option can be found on the add / edit insurance card form for a patient. The options for accepting assignment are yes or no.
What does accept assignment mean?
Just to be clear up front. This is NOT meant to be legal or coding advice. You should always check with the individual insurance plan or program (especially if you are a participating or in-network provider). If you are a participating (or in-network) provider for an insurance company, then you should always check the contract that you have with that payer.
It would nearly be impossible for Therabill to give a general definition of "Accept Assignment". But if we were to give a general meaning for accept assignment, it would be as follows.
- You are indicating that the case is being assigned to you and payment should be sent to you. If you indicate No, then you are indicating that payment should be sent to the patient.
- You are accepting the payers rate for the service. You may be paid at a lower rate than what you charge for that service.
Can I freely choose to accept assignment or not to accept assignment.
Usually, the answer is no. If you are billing Medicare, then you usually have to accept assignment. If you are an in-network provider, then you probably need to accept assignment. You should call the payer to find out whether or not you can not accept assignment.
I accepted assignment and the payer still sent payment to the patient.
You should call the payer to find out why they are sending payment to the patient. Indicating that you accept assignment and having Box 13 of the CMS-1500 filled with patient signature (or on file) should indicate to the payer to send payment to the billing provider (Box 33 of the CMS-1500). However, there are always cases where the payer doesn't send payment to the billing provider even when you have the CMS-1500 filled in correctly.
I did not accept assignment and payer still paid me.
You should call the payer to find out why they are sending payment to you instead of the patient. Indicating that you do not accept assignment and not having Box 13 of the CMS-1500 filled with patient signature (or on file) should indicate to the payer to send payment to the patient However, there are always cases where the payer sends payment to the billing provider even when you have the CMS-1500 filled in correctly.
What does Therabill do when I do not accept assignment for a patient.
Therabill will fill out the CMS-1500 in the correct way to indicate that you do not accept assignment. Box 13 will be left blank and Box 27 will be marked as NO on the CMS-1500. However, Therabill also uses the accept assignment to automatically set the status of your sessions to Closed / Patient Due after you have billed the session out to insurance. Here is an explanation.
Remember, Therabill keeps a status of all of your therapy sessions (charges) to help you with your revenue cycle management. When you create a new session, and you indicate that you want to initially bill it to insurance, then the status of that session is considered open (open to insurance). A session that is open to insurance will show up as a pending charge on the client statement (billing your patient using Therabill). If you send a session in to the bill insurance area for a patient that you did not accept assignment for, then once you actually create the insurance claim, Therabill will automatically change the status of the session (charge) to closed. A closed session is a session that is closed to insurance and the patient owes the remaining balance due (the balance due is the charge amount minus any payments and adjustments applied to it).
Where do I indicate that I do not accept assignment for a patient.
This is on the add / edit insurance card form for a patient. At the bottom of the add / edit insurance card form (in the Advanced section), you will see an option to indicate whether you accept assignment. Make your selection there for the insurance card and then apply the edits. IMPORTANT: Always remember to save the client before you close the edit client form.
Can I set a default accept assignment?
Yes. By default, Therabill will always mark Accept Assignment as Yes when you are adding a new patient in Therabill. If you would like Therabill to automatically choose No when you are adding a new patient, then you will want to change your global settings for the clients. To do this, in the top navigation bar of Therabill, hover your mouse over Admin and then in the drop down menu, put your mouse over Defaults/Settings. In the sub-menu that appears, choose "Client Settings". In the client settings page, put No next to Accept Assignment and then (important) Save.
NOTE: Changing the default accept assignment does not change anything you already have entered in to Therabill. If you have already entered clients, and those clients were entered with accept assignment as Yes, then changing the default accept assignment to "No" will not change the accept assignment on those already entered patients.
- A doctor who accepts assignment is agreeing to charge you no more than the amount Medicare pays for the service you receive. Medicare pays 80 percent of this amount, and you pay 20 percent (after you’ve met your annual Part B deductible). The doctor bills Medicare directly, as you are “assigning” Medicare to pay the doctor for your care.
- The preventive services that Medicare now provides for free (such as mammograms, colonoscopies, heart disease screenings and many others) are free of charge only if they’re provided by a doctor or other qualified health provider who accepts assignment.
- A doctor who does not accept assignment can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive.
- A doctor who has opted out of Medicare cannot bill Medicare for services you receive and is not bound by Medicare’s limitations on charges. You enter into a private contract with the doctor, agreeing to pay his or her bills directly. You cannot claim reimbursement from Medicare under this arrangement.
The chart shows an example of what Medicare pays and what you pay under each of these scenarios:
|Doctor accepts assignment||Doctor does not|
|Doctor has opted out of Medicare|
|Amount Medicare approves||$100||$100||NA|
|Medicare pays||$80 (80%)||$80 (80%)||$0|
|You pay||$20 (20%)||$20 (20%)||$120|
|Additional charge above Medicare-approved amount||$0||$15 (maximum|
15% in excess of amount Medicare approves)
|You pay in total||$20||$35||$120|
The same rules apply not just to doctors but also to most other outpatient providers. However, suppliers of durable medical equipment (such as wheelchairs and oxygen equipment) that don’t accept assignment are not bound by Medicare’s limits rule on charges and are allowed to bill you more than 15 percent above the Medicare-approved amount.
These rules affect you only if you’re in traditional Medicare. If you’re enrolled in a Medicare private health plan, you pay what your plan requires, as explained in the plan’s information packet and on its website.
To find doctors in your area who participate in Medicare (including those who accept assignment on all claims), go to Medicare's "Physician Compare" website. Or call the Medicare help line at 1-800-633-4227.
Patricia Barry is a senior editor for AARP Integrated Media and the author of “Medicare For Dummies” (Wiley/AARP, October 2013).
Also of interest: How would you strengthen Medicare?