Participating Physicians

To avoid excess charges, consider seeing doctors and medical suppliers who accept Medicare assignment. They are called "participating" doctors and suppliers.

What is “Accepting Assignment”?

When a doctor or supplier agrees to accept Medicare assignment, it means he or she agrees to accept the Medicare allowed amount as the full charge for all covered services on the Medicare-assigned claim. The doctor or supplier submits the claim to the Medicare Contractor; the Contractor pays 80% of the Medicare allowed charge directly to the doctor, and the doctor can bill you up to the remaining 20% of the Medicare approved charge (plus any part of the annual deductible that has not yet been paid).

The names, addresses, and telephone numbers of Medicare participating doctors and suppliers are listed in the Medicare Participating Physician/Supplier Directory (MEDPARD).

New England

Directories are also available for review in all Social Security offices, state and area offices of the Administration on Aging, state Elder Affairs offices and in most hospitals in California. In addition, Medicare participating doctors and suppliers can display an emblem or certificate showing they accept assignment on all Medicare claims.

Medicare also has Nonparticipating Providers -

Physicians/suppliers who do not sign an agreement to accept assignment on all Medicare claims. Non-assigned claims can bill 15% above the approved amount. They may accept assignment on a claim-by-claim basis. There is a limiting charge amount for non-assigned claims.

Protect your pocketbook and always ask your doctors and medical suppliers if they accept assignment on Medicare claims.

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08/29/2008