If you still get confused about accepting assignment on Medicare claims, you are not alone. We get a lot of questions about the topic from new and experienced billers alike.

In general, non-participating Medicare suppliers are allowed to decide whether or not to accept assignment on a claim-by-claim basis. Of course, there are exceptions to the general rule.

A frequently overlooked exception relates to dual-eligible beneficiaries. Medicare requires suppliers to accept assignment on claims related to individuals that qualify for both Medicare and full state Medicaid benefits.

Next Episode: Thursday, June 20, 2024

Suppliers Must Accept Assignment for Dual-Eligible Beneficiaries

Medicare beneficiaries that also qualify for full state Medicaid benefits typically have very limited financial income. As a result, these individuals are unlikely to have the means to pay out-of-pocket healthcare expenses, certainly those that may arise from non-participating suppliers demanding more than the Medicare fee schedule allows. As such, Medicare requires all suppliers to accept assignment for these customers and limit their charges to the Medicare fee schedule as a protection for a population the agency deems vulnerable.

Though Medicare can require assignment, they do not force suppliers to accept dual-eligible customers. Suppliers may refuse the sale if accepting assignment is not financially viable for the needed product or service.