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What Are Medicare Part B Excess Charges?

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By Daniel Petkevich
Jan 6, 2023

Avoid excess charges and save money

In many instances, a doctor that accepts Medicare means that you won't have to worry about out-of-pocket costs. However, you might get nabbed with excess charges if your doctor accepts Medicare but doesn't accept assignment. What are excess charges? Let's find out.

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Definition of Medicare Part B Excess Charges

Medicare Part B excess charges are fees a healthcare provider may charge beyond the Medicare-approved amount for a service or item. This additional fee is only applied to Medicare beneficiaries by outpatient providers who do not accept assignment.
Assignment means that the provider agrees to take the approved Medicare amount as payment in full for the item or service provided. But if your doctor doesn't accept assignment, they can charge you more than the Medicare-approved amount.
These extra charges will increase your out-of-pocket costs and can add up quickly if you receive multiple services from a provider who does not accept assignment.

How Do Healthcare Providers Apply Excess Charges to Medicare Beneficiaries?

When a provider applies excess charges to Medicare beneficiaries, they must provide a written notice informing you of their policy before providing services. This is called an Advance Beneficiary Notice (ABN), and it outlines the cost for the service or item that could be charged above the approved amount.
If you agree to receive the service with the additional charge, the provider must give you a copy of the ABN and have you sign it. The signature acknowledges that you understand what services will be provided and at what cost.
If you don't agree to pay for any excess charges, the provider cannot provide the service or item.

Tips for Finding Providers Who Accept Assignment and Avoiding Excess Charges

The best way to avoid excess charges is to find a healthcare provider who accepts assignment. Here are some tips to help you find one:
  • Check online directories of Medicare-approved providers, like Medicare's Physician Compare tool or your plan’s directory.
  • Ask your current doctor if they accept assignment and what fees they charge for services.
  • Find out if other healthcare providers in your area accept assignment and what fees they charge for services.
  • Ask your friends, family members or support network about their experiences with different healthcare providers in terms of accepting assignment and costs.
  • Check if the provider participates in Medicare's Shared Savings Program, which can help reduce costs for services.
It’s important to do your research and find a healthcare provider who accepts assignment whenever possible. This can help you avoid expensive excess charges and keep your out-of-pocket health care costs affordable.

Examples of Situations Where a Provider May Charge an Excess Fee Above the Medicare-Approved Amount

In most cases, providers who accept Medicare also accept assignment and charge the approved amount. However, there are some instances in which a provider may choose to charge an excess fee:
  • The service or item is not covered by Medicare.
  • The provider does not usually participate with Medicare but is willing to do so for the patient on a one-time basis.
  • The provider is not enrolled in Medicare but they are legally allowed to provide services to Medicare beneficiaries.
  • The service or item is provided multiple times within a certain period of time and Medicare does not reimburse providers at the same rate for every instance.
  • The provider is in a rural area and does not have any other options for providing the service or item.
Remember, you should try to find providers who accept assignment whenever possible to avoid excess charge fees.

Conclusion

When seeking healthcare services or items as a Medicare beneficiary, it's important to find providers who accept assignment. Doing so will help you avoid excess charges and keep your out-of-pocket costs affordable. Before committing to any service or item, read the Advance Beneficiary Notice (ABN) and understand exactly how much you may be charged for it. And remember, for any Medicare questions you have; we are here to help. Call our team of experts at Fair Square Medicare.

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