📄 Non-Assigned Claims Are NOT So Scary – Condensed Summary
*Reference: Full PDF - Non assigned claims are not that scary
đź©ş Overview
“Non-assigned” claims simply mean the DME supplier chooses not to accept Medicare assignment for that claim.
The supplier is not paid directly by Medicare and may collect payment directly from the beneficiary.
Despite the scary name, these claims are legitimate, regulated, and sometimes strategically beneficial.
🏛️ Participating vs. Non-Participating Suppliers
Participating Supplier
- Must always accept assignment on all Medicare claims.
- Paid directly by Medicare.
- Bound by Medicare’s fee schedule as full payment.
- Patient only owes 20% coinsurance and unmet deductible.
Non-Participating Supplier
- Can choose per-claim whether to accept assignment.
- If non-assigned, supplier collects payment directly from the patient and Medicare reimburses the beneficiary.
- Supplier can charge more than Medicare’s allowed amount, but must inform the patient first.
- Payment goes to the patient, not the supplier.
💵 What “Non-Assigned” Really Means
- You file the claim to Medicare for the patient’s reimbursement, not your own.
- The patient pays you up front.
- Medicare sends the allowable payment (usually 80%) directly to the patient.
- Suppliers must still use valid HCPCS codes, modifiers, and documentation as usual.
⚖️ Supplier Requirements
- Suppliers must be enrolled and approved with Medicare to submit non-assigned claims.
- You cannot submit a claim “non-assigned” to avoid compliance requirements — all rules still apply.
- You must still issue an ABN (Advance Beneficiary Notice) when required.
- Always submit the claim electronically (or on a CMS‑1500 form) with the “non-assigned” indicator.
👩‍⚕️ Beneficiary Rights
- The beneficiary may submit the claim themselves if the supplier doesn’t.
- They’ll receive payment directly from Medicare.
- The patient can use this payment to reimburse the supplier or keep it if they already paid.
- Medicare’s payment is still based on the Medicare fee schedule, regardless of what the supplier charged.
📜 Anti‑Discrimination and Fair Billing
- Suppliers cannot discriminate or refuse service solely because a patient uses Medicare.
- Prices must be consistent and reasonable, even for non‑assigned claims.
- Suppliers may charge higher than Medicare’s allowed rate, but must communicate up front what the patient will owe.
⚙️ Upgrades and Patient Choice
- For upgrades (e.g., deluxe wheelchairs, advanced CPAP models):
- Supplier can offer the patient a non‑assigned option for upgraded features.
- The patient pays the difference out of pocket.
- Medicare reimburses the basic allowable amount to the patient.
- Always document clearly that the patient requested and agreed to pay the difference.
💡 Why Suppliers Use Non‑Assigned Claims
- Avoids lengthy Medicare payment delays.
- Allows flexible pricing for non‑covered or upgraded items.
- Encourages patient choice for higher-end equipment.
- Keeps suppliers compliant while maintaining revenue control.
đźš« Risks and Cautions
- You must still submit the claim to Medicare (even non‑assigned).
- You cannot balance bill beyond what was agreed with the patient.
- Always ensure ABN forms are issued properly when items are likely non‑covered.
- Avoid misuse — non‑assignment is a privilege, not a loophole.
âś… Key Takeaways
| Topic | Assigned | Non‑Assigned |
|---|---|---|
| Who bills Medicare? | Supplier | Supplier |
| Who gets paid by Medicare? | Supplier | Patient |
| Supplier allowed to charge over fee schedule? | ❌ No | ✅ Yes (within reason) |
| Claim must still be submitted to Medicare? | âś… Yes | âś… Yes |
| ABN required for non‑covered items? | ✅ Yes | ✅ Yes |
| Documentation standards | Same for both | Same for both |
Bottom line:
Non‑assigned claims are legal, flexible, and useful for DME suppliers — as long as you stay compliant, transparent, and document thoroughly.
Source: CGS Administrators, LLC – “Non‑Assigned Claims Are NOT So Scary” presentation materials.