Choosing to bill non-assigned claims

Our note: There’s been some confusion around Non-Assigned Claims so we asked “our resident expert” Mary Stoner President of IMCO Home Care’s Resource Partner, EBS to break it down for us.

Written by: Mary Stoner, EBS Electronic Billing Services, Inc.

With the rural rate reductions that took effect on July 01, 2016, we are seeing more and more providers that are choosing to bill NON-assigned claims. Billing non-assigned means that you (the supplier) are NOT willing to accept the Medicare (or insurance) allowable as your payment in full. You would charge the patient the full retail price, at the time of service, then file the claim non-assigned. Any money due to the patient will come directly from Medicare (or insurance) to the patient.

There are some exceptions and special rules we need to talk about:

First….to do a non-assigned claim with Medicare….you must be a non-participating provider. Let’s talk about the differences between being a participating provider and a non-participating provider:

Participating providers have made an agreement with Medicare that they will ALWAYS accept assignment.

Non-participating providers have not signed a participating agreement and can choose to bill non-assigned claims on a claim-by-claim basis; with the exception of prescription drugs and dual-eligible Medicare/Medicaid beneficiaries.

Medicare requires ALL drugs (immuno suppressive, oral anti cancer, anti emetic, respiratory meds, etc) be billed on an assigned basis. So….if the allowable on the prescription drug (plus the dispensing fee) is not high enough to cover your cost….then you have to choose to exercise on of the four following options:

  1. Bill it and take the loss (only charging the patient the deductible or coinsurance amounts)
  2. Call the ordering practitioner and switch to an alternative drug/product
  3. Have the patient pay for it and complete an ABN marking Option 3 (which means the patient does not want the Medicare program billed at all).
  4. Refer the patient to someone else

If you decide to bill rentals on a non-assigned basis, you will need to obtain a newly signed “Beneficiary Authorization” (often called the “One-Time Beneficiary Authorization”) each month prior to billing the non-assigned rental claim. The “OneTime” authorization is not allowed for monthly rentals. If for any reason that patient does not sign the authorization, I highly recommend getting the ABN completed with marking Option 3 (meaning the patient does not want you to bill the Medicare program). If you can’t get the Authorization or the ABN completed….then I recommend picking up your equipment!

One last thought….if you have some items that you are willing to accept assignment on and others that you want to bill non-assigned….you will need to supply them on DIFFERENT dates of service. Otherwise, Medicare will claim that you are fragment billing, which is against Federal Regulations. So….ALL items dispensed on a specific date of service need to be either assigned or non-assigned.

EBS is a national DME billing and consulting company. For more information on how EBS can streamline your process, resolve billing, reconciliation, and audit recovery issues, call Mary Stoner at 573-481-2921 or email mstoner@ebsservice.com

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