How?
By billing the claim as an “unassigned” claim (also called non-assigned).
What is an unassigned claim?
An unassigned claim is when a non-participating provider does not accept “assignment” from Medicare for the claim. This is an option for our titanium TiLite chairs because they are not competitively bid.
What is required to bill unassigned?
The provider must still file the claim on behalf of the user, but does so unassigned. The documentation and justification paperwork is still the same as a “normal” claim when submitting.
How does the provider get paid?
Once the unassigned claim is sent to Medicare by the provider, the user pays for the entire cost of the chair upfront. Once the claim is approved, Medicare pays the allowed amount for the chair directly back to the enrollee.
What are the advantages of billing unassigned?
For the user of the chair, they can continue to get the product they want and deserve and still, at the end of the day, only pay for the cost of the upgrade and their co-pay out of pocket like before. For the provider, they get the cost of the chair paid at the beginning without having to wait for Medicare to pay them back.
Bottom line, handled correctly, the result should be:
- Affordable reimbursement for the provider.
- Faster return on the provider’s investment.
- Same financial outcome for the beneficiary.
- Access to the product they wanted and could afford.
Have an interested user or dealer? Tell them to reach out to Jim Stephenson at jim.stephenson@permobil.com for more details about billing unassigned and how they can ensure their clients get the best, most appropriate product they want and deserve!
Jim Stephenson
Reimbursement and Coding Manager
Jim Stephenson is the Reimbursement and Coding Manager at Permobil. Over the past 25 years, he has worked on all sides of the healthcare reimbursement spectrum, the last 15 years in the CRT/DME industry. His broad background has provided him with vast experience and a unique perspective in working with funding sources, providers, physicians/clinicians and consumers. He is currently a member of the DME MAC Advisory Councils, the Complex Rehab and Mobility Council (CRMC) and the Regulatory Council for the American Association for Homecare. At Permobil, he works closely with the product development, government affairs, clinical education, sales and marketing teams. His responsibilities include: assisting providers with their coding and billing inquiries, providing support to the sales and customer service staffs and staying abreast of the ever-changing complex rehab industry.