Question

When a provider does not accept assignment from Medicare, the most that can be charged to the patient is ___ percent of the Medicare-approved amount.

Select one:
a.115
b.85
c.150
d.100

Answer 1

Medicare's limiting charge is 115% of the Medicare-approved amount. Providers who do not accept assignment can only charge up to this limit. The correct answer is option a.

Step-by-step explanation:

When a provider does not accept assignment from Medicare, the most that can be charged to the patient is 115 percent of the Medicare-approved amount. This means if the physician chooses not to accept the Medicare fee schedule as full payment, they can only charge up to 15% over the Medicare-approved rate for a particular service or item.

This rule is known as the 'limiting charge' and protects Medicare beneficiaries from being charged excessive amounts above the approved Medicare rates. However, it's important to note that not all services may be subject to this limiting charge, and there may be some situations where different rules apply.

Always check the specific circumstances and the service in question when dealing with Medicare charges. Patients should also be informed in advance if the provider does not accept Medicare assignment.