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