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Understanding Assignment on Medical Claim Forms: Key Differences for Commercial Policies and Medicare
The field for accepting assignment is located in box 27 on the medical claim form:
When submitting claims, understanding the assignment box on the claim form is crucial for ensuring proper reimbursement. Specifically, box 27 plays a pivotal role in determining where payments will be directed. This article will clarify the implications of selecting "yes" or "no" in this box, particularly for commercial policies and Medicare.
Assignment for Commercial Policies
For commercial insurance policies, the assignment box (box 27) serves as a straightforward indicator of where reimbursement will go:
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Selecting "Yes": When you check "yes" in box 27, you are indicating that the payment for services rendered should be sent directly to your office. By accepting assignment, you typically do not collect the full amount upfront from the patient. Instead, you collect a portion and then either balance bill or write off the remaining amount once the claim is processed, depending on your financial policies. This approach indicates to the insurer that reimbursement should be sent directly to the practice, however, it's important to keep in mind that some insurance companies may have a policy to only send checks to the patient. For these plans, it's important to set up a financial arrangement with the patient or collect payment in advance of the procedure.
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Selecting "No": If you select "no," the reimbursement will be directed to the patient. This means the patient will receive the payment. Oftentimes if a provider charges full fee for the service up front, they will then choose to have the reimbursement sent directly to the patient.
Assignment for Medicare Claims
Medicare operates under slightly different rules regarding assignment, which can impact how providers choose to handle their billing:
Note: If you are a participating Medicare provider, you can only accept assignment. If you are a non-participating Medicare provider, you have the choice to accept or not accept assignment. You must be a Medicare provider, either par or non-par, with an active PTAN number to bill Medicare.
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Accepting Assignment: When providers accept assignment on a Medicare claim, they agree to the payment terms set by Medicare. In this case, reimbursement will still be directed to the provider's office, similar to selecting "yes" for commercial policies. However, it comes with specific stipulations:
- Providers must accept Medicare’s approved fees and cannot charge patients more than this amount (known as balance billing).
- This can be beneficial for patients, as it limits their out-of-pocket costs.
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Not Accepting Assignment: Providers may choose not to accept Medicare assignment, allowing them greater flexibility in billing:
- If they do not accept assignment, the reimbursement will go to the patient, who can then pay the provider directly.
- This approach allows providers to set their own fees, which can be higher than Medicare’s approved amounts. However, it also means they can balance bill the patient for the difference, potentially leading to higher costs for patients.
Conclusion
Understanding the implications of the assignment box on medical claim forms is essential for both healthcare providers and patients. For commercial policies, the choice between "yes" and "no" directly affects cash flow and billing processes. For Medicare, the decision to accept or not accept assignment has broader implications on reimbursement, provider fees, and patient costs.
Providers must carefully consider these options to ensure compliance with regulations and maintain transparency with their patients, ultimately enhancing the billing experience for everyone involved.