In the wake of new market pressures, upgrades, non-assigned claims and cash sales are taking center stage. The market has changed and your business should contemplate the suitability of these options, but they are not appropriate in all cases. This is the second article in a four part mini-series to break down the top myths of filing non-assigned claims and leveraging upgrades and cash sales. Below you will find the second myth in the series:
Myth #2: DME suppliers are bound by a “limiting charge” when billing non-assigned, and beneficiaries cannot be charged more than a certain percentage over the Medicare fee schedule allowable.
Myth #2: DME suppliers are bound by a “limiting charge” when billing non-assigned, and beneficiaries cannot be charged more than a certain percentage over the Medicare fee schedule allowable.
This is FALSE.
The “limiting charge” concept applies to Part B services like physician visits, but does not apply to durable medical equipment. The limiting charge restricts physician collections to a maximum of 115% of the Medicare fee schedule when they file non-assigned. Physicians are further subject to a participation penalty when they do accept assignment (non-par physicians receive a maximum of 95% of fee schedule amounts when they do accept assignment). Neither the participation penalty nor the limiting charge apply to durable medical equipment. The CMS publication titled “Medicare Coverage of Durable Medical Equipment and Other Devices” states, “If a DME supplier doesn’t accept assignment, there’s no limit to what they can charge you.”
Do you have a question you want us to cover for this series? Post a comment on our website or email us at info@miravistallc.com with the subject “MythBuster”. Then stay tuned for more myth busting from Andrea Stark and MiraVista.
The “limiting charge” concept applies to Part B services like physician visits, but does not apply to durable medical equipment. The limiting charge restricts physician collections to a maximum of 115% of the Medicare fee schedule when they file non-assigned. Physicians are further subject to a participation penalty when they do accept assignment (non-par physicians receive a maximum of 95% of fee schedule amounts when they do accept assignment). Neither the participation penalty nor the limiting charge apply to durable medical equipment. The CMS publication titled “Medicare Coverage of Durable Medical Equipment and Other Devices” states, “If a DME supplier doesn’t accept assignment, there’s no limit to what they can charge you.”
Do you have a question you want us to cover for this series? Post a comment on our website or email us at info@miravistallc.com with the subject “MythBuster”. Then stay tuned for more myth busting from Andrea Stark and MiraVista.
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