What is the correct statement about the limiting charge in the non-participating scenario?

What is the correct statement about the limiting charge in the non-participating scenario?

• A. It applies only to non-participating providers who do not accept assignment
• B. It applies regardless of assignment
• C. It equals the deductible amount
• D. It equals the full billed amount

Answer: (A)

Limiting charge is a cap on what a non-participating provider who does not accept assignment can bill a patient with Medicare Part B. This applies only in the situation where the provider is non-participating and does not agree to accept assignment for that patient’s claim. It does not apply to providers who accept assignment, and it is not the deductible or the full billed amount. In practice, this means the provider cannot bill more than the allowed limit when they don’t accept assignment.

Limiting charge is a cap on what a non-participating provider who does not accept assignment can bill a patient with Medicare Part B. This applies only in the situation where the provider is non-participating and does not agree to accept assignment for that patient’s claim. It does not apply to providers who accept assignment, and it is not the deductible or the full billed amount. In practice, this means the provider cannot bill more than the allowed limit when they don’t accept assignment.