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A medical provider that accepts Medicare Assignment must ________.

1) accept payment based upon a defined Medicare schedule and bill the insured for any difference
2) accept payment based upon a defined Medicare schedule and negotiate any excess fees
3) accept payment based upon a defined Medicare schedule and bill no more than 15
4) accept payment based upon a defined Medicare schedule as payment in full

User Jassiel
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Final answer:

Medical providers who accept Medicare Assignment must adhere to the Medicare-approved amount as full payment for services, billing patients only for any deductible and copayment required. Option 4 is correct.

Step-by-step explanation:

Healthcare providers participating in Medicare Assignment commit to accepting payment according to a predetermined Medicare fee schedule, acknowledging the Medicare-approved amount as the complete payment for their services. By adhering to this agreement, providers are prohibited from charging patients amounts beyond the established deductible and copayment. This arrangement ensures that the financial responsibility for Medicare beneficiaries is confined to these predetermined limits, promoting cost predictability and protection for patients.

In contrast, within a fee-for-service system, healthcare providers receive compensation for each specific service rendered. The reimbursement is directly linked to the quantity and nature of the services provided, creating a payment structure that corresponds to the individual procedures, tests, or treatments administered.

Conversely, in a health maintenance organization (HMO), providers operate under a distinct compensation model. Instead of being reimbursed per service, they receive a fixed amount per patient, irrespective of the number of services delivered. This approach aligns with the HMO's emphasis on preventive care and cost control, encouraging a proactive and holistic approach to patient health while maintaining financial stability through predetermined, per-patient compensation arrangements.

User Solerous
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