Questions regarding Medicare regarding accepting and not accepting is a big issue.  I will show you two examples to help you.

Case 1: Accepting Assignment

Accepting assignment means that you will accept the fee Medicare allow as payment in full and that you cannot charge the patient any additional amount.  However, you still should charge any Deductible and Copayment if that is listed on the procedure you are providing.

1. Medicare allows payment of approximately $1,950.00

2. The patients deductible is $185.and 20% copayment. 

3. After those are deducted, Medicare pays $1,410.oo and the out of pocket is $538.00

Case 2: Not Accepting Assignment

Not accepting means billing your office fee office fee and the patient will get the rebate check.  However, some states have a maximum amount you can charge so the amount could be discounted.  Texas is one of those States. As a non participating provider you can choose to wait for Medicare or have the patient pay in full and let Medicare pay the patient. (States that may discount your fee will require you to pay the patient back for over payment.)

1. Doctor charges $2,000.00 which the patient pays up front. .

2. Medicare allows payment of approximately $1,150.00

3. The patient is still responsible for $185.00 deductible and 20% copay

4. Out of the total billed, the payment from Medicare was $772.00

When you are making choices dealing with Medical don't forget to get some expert advice on your choice.  Each State has their own set of rules and fee plans are set up by the zip code.  Contact either Jan Palmer Or Christine Taxin thru and we will help you with the choices you may have in your state.


Christine Taxin
36 Abington Avenue
Ardsley New York 10502
United States of America