A Medicare 'participating' physician who accepts assignment agrees to...
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A participating physician signs a contract with Medicare to accept assignment on all Medicare claims, meaning the doctor accepts the Medicare-approved amount as full payment for covered services. Medicare pays its 80% share, and the beneficiary is responsible only for the 20% coinsurance and any unmet deductible. By contrast, a non-participating provider may balance bill the beneficiary beyond the approved amount, subject to the limiting charge. This assignment-versus-non-assignment distinction, which directly affects the beneficiary's out-of-pocket cost, is a claims-handling point tested in the Medicare section of the senior health products outline.
Why the other options are wrong
- B) Billing above the approved amount describes non-participating providers, not those who accept assignment.
- C) Participating providers accept Medicare patients under the assignment agreement.
- D) Payment is made through Medicare's claims process, not prepaid in full by the patient.
Memory hook
Assignment = the doctor accepts Medicare's approved number as full payment.