Questions for those on Medicare (or who have experience with it)

[yellowdogintexas]

51. doctors accepting Medicare fees

what you want to ask the office mgr at the surgeon's office is whether the doctor 'accepts assignment' on Medicare

a simple example of what this means:

$100 service $60 'usual and customary rate" (used to be called the area prevailing rate)

dr doesn't accept assignment : Medicare pays the doctor 80% of $60 and you may be billed for the remaining amount
There may be a cap built in there. I used to process these claims and that was how it worked then. Some things have changed.

Dr does accept assignment: Medicare pays the doctor 80% of $60 and you are responsible for 20% of $60.

Moral of the story : choose physicians who accept Medicare assignment.
If you have surgery there will be an anesthesiologist and a million labs. You have no choice in whether these providers accept assignment but usually the interpretation of your labs will be assigned

the facility bills under part A. the docs bill under Part B