Health · Chapter 17 · Parts A & B
Assignment, MSN & Appeals
Definition
Participating providers accept assignment: Medicare's approved fee is full payment, paid directly — balance billing prohibited. Nonparticipating providers may charge up to 15% above the fee schedule and collect from the patient. Claims run through regional MACs; beneficiaries get a quarterly Medicare Summary Notice (not a bill) and may appeal via a Redetermination Request within 120 days.
Easy to confuse with
These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.
Related terms