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Accept Assignment - CMS 1500 Box 27

Solution

What does Accept Assignment mean?

The definition and use of Accept Assignment vary between payers, especially Medicare. However, the general definition states that:

  • You indicate the case is assigned to you and that payment should be sent to you.
  • You are accepting the payer's rate for the services rendered, even if it is lower than your CPT Fee Schedule.

Do I have to Accept Assignment?

The short answer is no. If you are a non-participating provider (out-of-network), you have the option to not accept the assignment, depending on the insurance program.

I selected to Accept Assignment, but the payer sent payment to the client.

First, you should look at the client's insurance card in the application and verify that Signature on File is checked. This relates to Box 13 on the CMS-1500 and indicates if the client authorizes payment to your clinics.

If this is checked, you will need to contact the payer to find out why the payment was not sent to you.

did not Accept Assignment and payer still paid me.

First, you should look at the client's insurance card in the application and verify that Signature on File is unchecked. This relates to Box 13 on the CMS-1500 and indicates if the client authorizes payment to your clinics.

Whenever Accept Assignment is set to No, the payer should send payment to the client regardless if the Signature on File box is checked. However, some payers may ignore this and still send your clinic the payment. You will need to contact the payer find out why the payment was not sent to the client.

What does the application do when I do not Accept Assignment?

As mentioned previously, if you do not Accept Assignment, you are expecting the insurance company to reimburse the client directly. This indicates that you will need to collect payment for the services from the client.

 
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Article details
Article ID: 195
Category: Insurance Billing
Date added: 25-Jun-2020 4:21am
Views: 3
Rating (Votes): Article not rated yet (0)

 
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