What is the difference between “participating” and “non-participating” suppliers of durable medical equipment (DME)?
A4. There are three types of Durable Medical Equipment (DME) suppliers. The one you choose affects how much your costs will be. • Suppliers who are enrolled and “participating” in Medicare must bill Medicare and accept assignment (the Medicare-approved amount) as payment in full. You can only be billed 20 percent of that amount (plus any unmet portion of your Part B deductible). • Suppliers who are enrolled but “not participating” in Medicare are not required to accept assignment. They are allowed to charge you their standard rate and can ask for payment up front. Medicare will then reimburse you for 80 percent of its approved amount, and you pay the balance. • Suppliers who are not enrolled in Medicare are not required to bill Medicare. You may have to submit the claim to Medicare yourself. These suppliers are allowed to charge you their standard rate and can ask for payment up front. Medicare may then reimburse you for 80 percent of its approved amount, and you pay the balance. 4.Not
Related Questions
- What is the difference between "participating" and "non-participating" suppliers of durable medical equipment (DME)?
- Can a non-participating Durable Medical Equipment (DME) provider accept assignment on some items and not others?
- We are a durable medical equipment provider. Does the Jurisdiction 15 transition include DME MAC claims?
