How much are providers paid by Medicare who elect not to participate in the Medicare program but who accept assignment on a claim?

Providers who decide not to participate in the Medicare program, but choose to accept assignment on a claim, are reimbursed at a rate that is 5 percent less than that of participating providers (PAR providers). This reimbursement structure is designed to offer some incentive for providers to formally participate in the Medicare program while still allowing non-participating providers to treat Medicare beneficiaries.

Accepting assignment means that the provider agrees to accept the Medicare-approved amount as full payment for the service, which ensures that beneficiaries do not have to pay more than what Medicare has set for that service. However, the reduction in payment compared to PAR providers reflects the expectation that participating providers offer a broader range of services and may have more streamlined processes for handling claims and patient care within the Medicare system.

In summary, while non-participating providers still have the option to accept assignment and provide services to Medicare beneficiaries, the financial arrangement recognizes the differences in their relationship with the Medicare program compared to those who actively participate.