Billing non-assigned: Myths, part 3

Editor's note: In the wake of new market pressures, upgrades, non-assigned claims and cash sales are taking center stage, says industry consultant Andrea Stark. The market has changed and your business should contemplate the suitability of these options, but they are not appropriate in all cases, she says. This is the second in a series of mini-articles that break down the top myths of filing non-assigned claims and leveraging upgrades and cash sales.

Myth #3:  Every claim can be filed as non-assigned.

This is FALSE.

The most significant roadblock to filing non-assigned is a supplier's participation status with Medicare. You must be non-participating to file a non-assigned claim. Your participation status with Medicare can be verified at www.medicare.gov using the “find a supplier” tool. Select a product you sell for a zip code located in your service area. If there is an “M” icon next to your company name, then you are a designated participating supplier and you must accept assignment on all your claims through the end of the year. This status can only be changed by sending a letter to the NSC in December that you no longer wish to participate. Participation status is governed at the tax ID level. If you multiple lines of business (hospital, home health, etc.), and any line participates, all lines must participate.

Another obstacle pertains to patients that are dual-eligible (meaning they have Medicare and Medicaid coverage). Medicare mandates assignment for these claims if you choose to service this group of beneficiaries. You do, however, have the right to refuse service.

Another barrier to filing non-assigned applies to pharmacies. Medicare mandates that all covered drugs be filed on an assignment basis. There are very few covered medications under Medicare Part B, but aerosol medications used with nebulizers, immunosuppressive medications for organ transplant patients, oral anti-emetic drugs for chemotherapy patients, and select medications infused through a pump are some of the medications subject to mandatory assignment.

If your company can clear the three hurdles listed above, filing non-assigned may help you cross the finish line.