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Term
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Definition
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Assignment
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In the Original Medicare, this means a doctor or supplier agrees to accept the Medicare-approved
amount as full payment. If you are in the Original Medicare, it can save you money if your doctor
accepts assignment. You still pay your share of the cost of the doctor's visit.
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Other Healthcare Professional
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Other types of health professionals, who are not physicians, include nurse practitioners, physician
assistants, social workers, psychologists, and physical therapists.
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Other Healthcare Professional – Medicare Participation
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Most healthcare professionals listed participate in Medicare. This means they agree to accept mandatory assignment in all claims. These healthcare professionals may only bill you your share of the costs (deductible and coinsurance amounts). Medicare pays them directly.
Healthcare Professionals that are not required to accept assignment are:
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- Audiologist
- Psychologist who bill independently
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- Physical Therapists
- Occupational Therapists
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Check with these other healthcare professionals to see if they accept assignment on Medicare claims and covered services.
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Physician
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Physicians are one type of healthcare professional that cares for patients. There are many types of physicians,
such as primary care physicians, cardiologists, radiologists, and surgeons.
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Physician - Medicare Participation
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Participating physicians agree to accept assignment on all claims. These physicians may only bill you your
share of the costs (deductible and coinsurance amounts). Medicare pays the physician directly.
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Physician Quality Reporting Initiative (PQRI)
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The PQRI is a voluntary program that allows physicians and other healthcare professionals to report information to Medicare about the quality of care they give to people with Medicare who have certain medical conditions.
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Individual Practice Locations
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These are the locations where an individual physician provides services (like a doctor's office).
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Organization Practice Locations
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These are the locations of group practices, clinics, or other facilities where the physicians provide services.
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