Urology Coding Alert

Question: We have a patient who is new to Medicare asking why she has to pay anything when we accept assignment with Medicare. How do I explain it to her?

California Subscriber

Answer: If your providers accept assignment that means they agree to accept the Medicare payment amount for a particular item or service as its payment in full. But the patient must still pay the copayment, plus any applicable deductible.

If a patient asks what happens if she goes to a practice that doesn’t accept assignment, let her know that she may have to pay more than the Medicare amount at that office, although for most services a doctor’s office can only charge up to 15 percent more than the amount Medicare usually allows and pays. In the latter case scenario, the patient must pay for the treatment’s full cost upfront. You will then submit the paid claim to Medicare, and Medicare will directly reimburse the patient, minus any copayments or deductibles.