Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations!
Table of Contents
- Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations!
- What is the Definition of Medicare Assignment?
- Examples of Medicare Assignment Violations
Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations!
Most Medicare providers that bill claims to National Government Services, a CMS MAC, accept Medicare assignment. However, according to our records, NGS continues to receive Original Medicare assignment violation complaints from 1-800-MEDICARE.
You can help stop this bad behavior by understanding the following information and sharing this information with your compliance and billing staff, especially if they are new to Medicare.
What is the Definition of Medicare Assignment?
Medicare-approved amount as full payment for a covered service. This is called “accepting assignment.” If a provider accepts assignment, it's for all Medicare-covered Part A and Part B services.
A medical provider that accepts Medicare assignment must submit claims directly to Medicare on the beneficiary’s behalf. The provider is paid the agreed upon amount by Medicare, and the beneficiary will pay any coinsurance or deductibles.
Examples of Medicare Assignment Violations
- Breach of the Medicare participation or assignment agreements
- Mandatory claims submission, per Social Security Act (Section 1848(g)(4))
- Collecting more than 20% coinsurance or the deductible on claims filed with Medicare
- Improper billing practices such as exceeding the limiting charge
For more information, go to CMS MLN® Medicare Fraud & Abuse: Prevent, Detect, Report Booklet
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UPIC Western
Qlarant Integrity Solutions, LLC
Qlarant Website
States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, Utah, Washington, Wyoming
UPIC Midwestern
CoventBridge Group
CoventBridge Group Website
States: Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
UPIC Southwestern
Qlarant Integrity Solutions, LLC
Qlarant Integrity Solutions Website
States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
UPIC Northeastern
Safeguard Services, LLC
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States: Pennsylvania, New York, Delaware, Maryland, D.C., New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Rhode Island, Connecticut
UPIC Southeastern
Safeguard Services, LLC
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States: Alabama, Florida, Georgia, North Carolina, Puerto Rico, South Carolina, Tennessee, Virgin Islands, Virginia, West Virginia
OIG Hotline Operations
UPIC Contact Information
UPIC Western
Qlarant Integrity Solutions, LLC
Qlarant Website
States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, Utah, Washington, Wyoming
UPIC Midwestern
CoventBridge Group
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States: Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
UPIC Southwestern
Qlarant Integrity Solutions, LLC
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States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
UPIC Northeastern
Safeguard Services, LLC
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States: Pennsylvania, New York, Delaware, Maryland, D.C., New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Rhode Island, Connecticut
UPIC Southeastern
Safeguard Services, LLC
Safeguard Services Website
States: Alabama, Florida, Georgia, North Carolina, Puerto Rico, South Carolina, Tennessee, Virgin Islands, Virginia, West Virginia
OIG Hotline Operations
UPIC Contact Information
UPIC Western
Qlarant Integrity Solutions, LLC
Qlarant Website
States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, Utah, Washington, Wyoming
UPIC Midwestern
CoventBridge Group
CoventBridge Group Website
States: Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
UPIC Southwestern
Qlarant Integrity Solutions, LLC
Qlarant Integrity Solutions Website
States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
UPIC Northeastern
Safeguard Services, LLC
Safeguard Services Website
States: Pennsylvania, New York, Delaware, Maryland, D.C., New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Rhode Island, Connecticut
UPIC Southeastern
Safeguard Services, LLC
Safeguard Services Website
States: Alabama, Florida, Georgia, North Carolina, Puerto Rico, South Carolina, Tennessee, Virgin Islands, Virginia, West Virginia
OIG Hotline Operations