Does your provider accept Medicare as full payment?

You can get the lowest cost if your doctor or other health care provider accepts the Medicare-approved amount  as full payment for a covered service. This is called “accepting assignment.” If a provider accepts assignment, it’s for all Medicare-covered Part A and Part B services.

Using a provider that accepts assignment

Most doctors, providers, and suppliers accept assignment, but always check to make sure that yours do.

If your doctor, provider, or supplier accepts assignment:

  • Your out-of-pocket costs may be less.
  • They agree to charge you only the Medicare deductible and coinsurance amount, and usually wait for Medicare to pay its share before asking you to pay your share.
  • They have to submit your claim directly to Medicare and can't charge you for submitting the claim.

How does assignment impact my drug coverage?

Using a provider that doesn't accept Medicare as full payment

Some providers who don’t accept assignment still choose to accept the Medicare-approved amount for services on a case-by-case basis. These providers are called "non-participating."

If your doctor, provider, or supplier doesn't accept assignment:

  • You might have to pay the full amount at the time of service.
  • They should submit a claim to Medicare for any Medicare-covered services they give you, and they can’t charge you for submitting a claim. If they refuse to submit a Medicare claim, you can submit your own claim to Medicare. Get the Medicare claim form .
  • They can charge up to 15% over the Medicare-approved amount for a service, but no more than that. This is called "the limiting charge."  

Does the limiting charge apply to all Medicare-covered services?

Using a provider that "opts-out" of Medicare

  • Doctors and other providers who don’t want to work with the Medicare program may "opt out" of Medicare.
  • Medicare won’t pay for items or services you get from provider that opts out, except in emergencies.
  • Providers opt out for a minimum of 2 years. Every 2 years, the provider can choose to keep their opt-out status, accept Medicare-approved amounts on a case-by-case basis ("non-participating"), or accept assignment.

Find providers that opted out of Medicare.

Private contracts with doctors or providers who opt out

  • If you choose to get services from an opt-out doctor or provider you may need to pay upfront, or set up a payment plan with the provider through a private contract.
  • Medicare won’t pay for any service you get from this doctor, even if it’s a Medicare-covered service.

What are the rules for private contracts?

You may want to contact your  State Health Insurance Assistance Program (SHIP) for help before signing a private contract with any doctor or other health care provider.

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Medicare Assignment: Everything You Need to Know

Medicare assignment.

  • Providers Accepting Assignment
  • Providers Who Do Not
  • Billing Options
  • Assignment of Benefits
  • How to Choose

Frequently Asked Questions

Medicare assignment is an agreement between Medicare and medical providers (doctors, hospitals, medical equipment suppliers, etc.) in which the provider agrees to accept Medicare’s fee schedule as payment in full when Medicare patients are treated.

This article will explain how Medicare assignment works, and what you need to know in order to ensure that you won’t receive unexpected bills.

fizkes / Getty Images

There are 35 million Americans who have Original Medicare. Medicare is a federal program and most medical providers throughout the country accept assignment with Medicare. As a result, these enrollees have a lot more options for medical providers than most of the rest of the population.

They can see any provider who accepts assignment, anywhere in the country. They can be assured that they will only have to pay their expected Medicare cost-sharing (deductible and coinsurance, some or all of which may be paid by a Medigap plan , Medicaid, or supplemental coverage provided by an employer or former employer).

It’s important to note here that the rules are different for the 29 million Americans who have Medicare Advantage plans. These beneficiaries cannot simply use any medical provider who accepts Medicare assignment.

Instead, each Medicare Advantage plan has its own network of providers —much like the health insurance plans that many Americans are accustomed to obtaining from employers or purchasing in the exchange/marketplace .

A provider who accepts assignment with Medicare may or may not be in-network with some or all of the Medicare Advantage plans that offer coverage in a given area. Some Medicare Advantage plans— health maintenance organizations (HMOs) , in particular—will only cover an enrollee’s claims if they use providers who are in the plan's network.

Other Medicare Advantage plans— preferred provider organizations (PPOs) , in particular—will cover out-of-network care but the enrollee will pay more than they would have paid had they seen an in-network provider.

Original Medicare

The bottom line is that Medicare assignment only determines provider accessibility and costs for people who have Original Medicare. People with Medicare Advantage need to understand their own plan’s provider network and coverage rules.

When discussing Medicare assignment and access to providers in this article, keep in mind that it is referring to people who have Original Medicare.

How to Make Sure Your Provider Accepts Assignment

Most doctors, hospitals, and other medical providers in the United States do accept Medicare assignment.

Provider Participation Stats

According to the Centers for Medicare and Medicaid Services, 98% of providers participate in Medicare, which means they accept assignment.

You can ask the provider directly about their participation with Medicare. But Medicare also has a tool that you can use to find participating doctors, hospitals, home health care services, and other providers.

There’s a filter on that tool labeled “Medicare-approved payment.” If you turn on that filter, you will only see providers who accept Medicare assignment. Under each provider’s information, it will say “Charges the Medicare-approved amount (so you pay less out-of-pocket).”

What If Your Provider Doesn’t Accept Assignment?

If your medical provider or equipment supplier doesn’t accept assignment, it means they haven’t agreed to accept Medicare’s approved amounts as payment in full for all of the services.

These providers can still choose to accept assignment on a case-by-case basis. But because they haven’t agreed to accept Medicare assignment for all services, they are considered nonparticipating providers.

Note that "nonparticipating" does not mean that a provider has opted out of Medicare altogether. Medicare will still pay claims for services received from a nonparticipating provider (i.e., one who does not accept Medicare assignment), whereas Medicare does not cover any of the cost of services obtained from a provider who has officially opted out of Medicare.

If a Medicare beneficiary uses a provider who has opted out of Medicare, that person will pay the provider directly and Medicare will not be involved in any way.

Physicians Who Have Opted Out

Only about 1% of all non-pediatric physicians have opted out of Medicare.

For providers who have not opted out of Medicare but who also don’t accept assignment, Medicare will still pay nearly as much as it would have paid if you had used a provider who accepts assignment. Here’s how it works:

  • Medicare will pay the provider 95% of the amount they would pay if the provider accepted assignment.
  • The provider can charge the person receiving care more than the Medicare-approved amount, but only up to 15% more (some states limit this further). This extra amount, which the patient has to pay out-of-pocket, is known as the limiting charge . But the 15% cap does not apply to medical equipment suppliers; if they do not accept assignment with Medicare, there is no limit on how much they can charge the person receiving care. This is why it’s particularly important to make sure that the supplier accepts Medicare assignment if you need medical equipment.
  • The nonparticipating provider may require the person receiving care to pay the entire bill up front and seek reimbursement from Medicare (using Form CMS 1490-S ). Alternatively, they may submit a claim to Medicare on behalf of the person receiving care (using Form CMS-1500 ).
  • A nonparticipating provider can choose to accept assignment on a case-by-case basis. They can indicate this on Form CMS-1500 in box 27. The vast majority of nonparticipating providers who bill Medicare choose to accept assignment for the claim being billed.
  • Nonparticipating providers do not have to bill your Medigap plan on your behalf.

Billing Options for Providers Who Accept Medicare

When a medical provider accepts assignment with Medicare, part of the agreement is that they will submit bills to Medicare on behalf of the person receiving care. So if you only see providers who accept assignment, you will never need to submit your own bills to Medicare for reimbursement.

If you have a Medigap plan that supplements your Original Medicare coverage, you should present the Medigap coverage information to the provider at the time of service. Medicare will forward the claim information to your Medigap insurer, reducing administrative work on your part.

Depending on the Medigap plan you have, the services that you receive, and the amount you’ve already spent in out-of-pocket costs, the Medigap plan may pay some or all of the out-of-pocket costs that you would otherwise have after Medicare pays its share.

(Note that if you have a type of Medigap plan called Medicare SELECT, you will have to stay within the plan’s network of providers in order to receive benefits. But this is not the case with other Medigap plans.)

After the claim is processed, you’ll be able to see details in your MyMedicare.gov account . Medicare will also send you a Medicare Summary Notice. This is Medicare’s version of an explanation of benefits (EOB) , which is sent out every three months.

If you have a Medigap plan, it should also send you an EOB or something similar, explaining the claim and whether the policy paid any part of it.

What Is Medicare Assignment of Benefits?

For Medicare beneficiaries, assignment of benefits means that the person receiving care agrees to allow a nonparticipating provider to bill Medicare directly (as opposed to having the person receiving care pay the bill up front and seek reimbursement from Medicare). Assignment of benefits is authorized by the person receiving care in Box 13 of Form CMS-1500 .

If the person receiving care refuses to assign benefits, Medicare can only reimburse the person receiving care instead of paying the nonparticipating provider directly.

Things to Consider Before Choosing a Provider

If you’re enrolled in Original Medicare, you have a wide range of options in terms of the providers you can use—far more than most other Americans. In most cases, your preferred doctor and other medical providers will accept assignment with Medicare, keeping your out-of-pocket costs lower than they would otherwise be, and reducing administrative hassle.

There may be circumstances, however, when the best option is a nonparticipating provider or even a provider who has opted out of Medicare altogether. If you choose one of these options, be sure you discuss the details with the provider before proceeding with the treatment.

You’ll want to understand how much is going to be billed and whether the provider will bill Medicare on your behalf if you agree to assign benefits (note that this is not possible if the provider has opted out of Medicare).

If you have supplemental coverage, you’ll also want to check with that plan to see whether it will still pick up some of the cost and, if so, how much you should expect to pay out of your own pocket.

A medical provider who accepts Medicare assignment is considered a participating provider. These providers have agreed to accept Medicare’s fee schedule as payment in full for services they provide to Medicare beneficiaries. Most doctors, hospitals, and other medical providers do accept Medicare assignment.

Nonparticipating providers are those who have not signed an agreement with Medicare to accept Medicare’s rates as payment in full. However, they can agree to accept assignment on a case-by-case basis, as long as they haven’t opted out of Medicare altogether. If they do not accept assignment, they can bill the patient up to 15% more than the Medicare-approved rate.

Providers who opt out of Medicare cannot bill Medicare and Medicare will not pay them or reimburse beneficiaries for their services. But there is no limit on how much they can bill for their services.

A Word From Verywell

It’s in your best interest to choose a provider who accepts Medicare assignment. This will keep your costs as low as possible, streamline the billing and claims process, and ensure that your Medigap plan picks up its share of the costs.

If you feel like you need help navigating the provider options or seeking care from a provider who doesn’t accept assignment, the Medicare State Health Insurance Assistance Program (SHIP) in your state may be able to help.

A doctor who does not accept Medicare assignment has not agreed to accept Medicare’s fee schedule as payment in full for their services. These doctors are considered nonparticipating with Medicare and can bill Medicare beneficiaries up to 15% more than the Medicare-approved amount.

They also have the option to accept assignment (i.e., accept Medicare’s rate as payment in full) on a case-by-case basis.

There are certain circumstances in which a provider is required by law to accept assignment. This includes situations in which the person receiving care has both Medicare and Medicaid. And it also applies to certain medical services, including lab tests, ambulance services, and drugs that are covered under Medicare Part B (as opposed to Part D).

In 2021, 98% of American physicians had participation agreements with Medicare, leaving only about 2% who did not accept assignment (either as a nonparticipating provider, or a provider who had opted out of Medicare altogether).

Accepting assignment is something that the medical provider does, whereas assignment of benefits is something that the patient (the Medicare beneficiary) does. To accept assignment means that the medical provider has agreed to accept Medicare’s approved fee as payment in full for services they provide.

Assignment of benefits means that the person receiving care agrees to allow a medical provider to bill Medicare directly, as opposed to having the person receiving care pay the provider and then seek reimbursement from Medicare.

Centers for Medicare and Medicaid Services. Medicare monthly enrollment .

Centers for Medicare and Medicaid Services. Annual Medicare participation announcement .

Centers for Medicare and Medicaid Services. Lower costs with assignment .

Centers for Medicare and Medicaid Services. Find providers who have opted out of Medicare .

Kaiser Family Foundation. How many physicians have opted-out of the Medicare program ?

Center for Medicare Advocacy. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) updates .

Centers for Medicare and Medicaid Services. Check the status of a claim .

Centers for Medicare and Medicaid Services. Medicare claims processing manual. Chapter 26 - completing and processing form CMS-1500 data set .

Centers for Medicare and Medicaid Services. Ambulance fee schedule .

Centers for Medicare and Medicaid Services. Prescription drugs (outpatient) .

By Louise Norris Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology.

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What is Medicare assignment and how does it work?

Kimberly Lankford,

​Because Medicare decides how much to pay providers for covered services, if the provider agrees to the Medicare-approved amount, even if it is less than they usually charge, they’re accepting assignment.

A doctor who accepts assignment agrees to charge you no more than the amount Medicare has approved for that service. By comparison, a doctor who participates in Medicare but doesn’t accept assignment can potentially charge you up to 15 percent more than the Medicare-approved amount.

That’s why it’s important to ask if a provider accepts assignment before you receive care, even if they accept Medicare patients. If a doctor doesn’t accept assignment, you will pay more for that physician’s services compared with one who does.

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How much do I pay if my doctor accepts assignment?

If your doctor accepts assignment, you will usually pay 20 percent of the Medicare-approved amount for the service, called coinsurance, after you’ve paid the annual deductible. Because Medicare Part B covers doctor and outpatient services, your $240 deductible for Part B in 2024 applies before most coverage begins.

All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies , without paying a deductible or coinsurance if the provider accepts assignment. 

What if my doctor doesn’t accept assignment?

A doctor who takes Medicare but doesn’t accept assignment can still treat Medicare patients but won’t always accept the Medicare-approved amount as payment in full.

This means they can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive, called “balance billing.” In this case, you’re responsible for the additional charge, plus the regular 20 percent coinsurance, as your share of the cost.

How to cover the extra cost? If you have a Medicare supplement policy , better known as Medigap, it may cover the extra 15 percent, called Medicare Part B excess charges.

All Medigap policies cover Part B’s 20 percent coinsurance in full or in part. The F and G policies cover the 15 percent excess charges from doctors who don’t accept assignment, but Plan F is no longer available to new enrollees, only those eligible for Medicare before Jan. 1, 2020, even if they haven’t enrolled in Medicare yet. However, anyone who is enrolled in original Medicare can apply for Plan G.

Remember that Medigap policies only cover excess charges for doctors who accept Medicare but don’t accept assignment, and they won’t cover costs for doctors who opt out of Medicare entirely.

Good to know. A few states limit the amount of excess fees a doctor can charge Medicare patients. For example, Massachusetts and Ohio prohibit balance billing, requiring doctors who accept Medicare to take the Medicare-approved amount. New York limits excess charges to 5 percent over the Medicare-approved amount for most services, rather than 15 percent.

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How do I find doctors who accept assignment?

Before you start working with a new doctor, ask whether he or she accepts assignment. About 98 percent of providers billing Medicare are participating providers, which means they accept assignment on all Medicare claims, according to KFF.

You can get help finding doctors and other providers in your area who accept assignment by zip code using Medicare’s Physician Compare tool .

Those who accept assignment have this note under the name: “Charges the Medicare-approved amount (so you pay less out of pocket).” However, not all doctors who accept assignment are accepting new Medicare patients.

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What does it mean if a doctor opts out of Medicare?

Doctors who opt out of Medicare can’t bill Medicare for services you receive. They also aren’t bound by Medicare’s limitations on charges.

In this case, you enter into a private contract with the provider and agree to pay the full bill. Be aware that neither Medicare nor your Medigap plan will reimburse you for these charges.

In 2023, only 1 percent of physicians who aren’t pediatricians opted out of the Medicare program, according to KFF. The percentage is larger for some specialties — 7.7 percent of psychiatrists and 4.2 percent of plastic and reconstructive surgeons have opted out of Medicare.

Keep in mind

These rules apply to original Medicare. Other factors determine costs if you choose to get coverage through a private Medicare Advantage plan . Most Medicare Advantage plans have provider networks, and they may charge more or not cover services from out-of-network providers.

Before choosing a Medicare Advantage plan, find out whether your chosen doctor or provider is covered and identify how much you’ll pay. You can use the Medicare Plan Finder to compare the Medicare Advantage plans and their out-of-pocket costs in your area.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at  Kiplinger’s Personal Finance  and has written for  The Washington Post  and  Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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Find-A-Code Articles, Published 2014, August 1

What does accept assignment mean.

by   InstaCode Institute Aug 1st, 2014 - Reviewed/Updated Mar 5th

What does it mean to accept assignment on the CMS 1500 claim form - also called the HCFA 1500 claim form.? Should I accept assignment or not? What are the guidelines for accepting assignment in box 27 of the 1500 claim?

These commonly asked questions should have a simple answer, but the number of court cases indicates that it is not as clear cut as it should be. This issue is documented in the book “Problems in Health Care Law” by Robert Desle Miller. The definition appears to be in the hands of the courts. However, we do have some helpful guidelines for you.

One major area of confusion is the relationship between box 12, box 13 and box 27.  These are not interchangeable boxes and they are not necessarily related to each other.

According to the National Uniform Claim Committee (NUCC), the "Accept Assignment" box indicates that the provider agrees to accept assignment.  It simply says to enter an X in the correct box.  It does NOT define what accepting assignment might or might not mean.

It is important to understand that if you are a participating provider in any insurance plan or program, you must first follow the rules according to the contract that you sign. That contract supersedes any guidelines that are included here.

Medicare Instructions / Guidelines

PARTICIPATING providers MUST accept assignment according to the terms of their contract.  The contract itself states:

“Meaning of  Assignment  - For purposes of this agreement, accepting  assignment  of the Medicare Part B payment means requesting direct Part B payment from the Medicare program.  Under an  assignment , the approved charge, determined by the Medicare carrier, shall be the full charge for the service covered under Part B.  The participant shall not collect from the beneficiary or other person or organization for covered services more than the applicable deductible and coinsurance.”

By law, the providers or types of services listed below MUST also accept assignment:

  • Clinical diagnostic laboratory services;
  • Physician services to individuals dually entitled to Medicare and Medicaid;
  • Services of physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, certified registered nurse anesthetists, clinical psychologists, and clinical social workers;
  • Ambulatory surgical center services for covered ASC procedures;
  • Home dialysis supplies and equipment paid under Method II;
  • Ambulance services;
  • Drugs and biologicals; and
  • Simplified Billing Roster for influenza virus vaccine and pneumococcal vaccine.

NON-PARTICIPATING providers can choose whether to accept assignment or not, unless they or the service they are providing is on the list above.

The official Medicare instructions regarding Boxes 12 and 13 are:

“Item 12 – The patient's signature authorizes release of medical information necessary to process the claim. It  also authorizes payments of benefits  to the provider of service or supplier when the provider of service or supplier accepts assignment on the claim.” “Item 13 - The patient’s signature or the statement “signature on file” in this item  authorizes payment of medical benefits  to the physician or supplier. The patient or his/her authorized representative signs this item or the signature must be on file separately with the provider as an authorization. However, note that when payment under the Act can only be made on an assignment-related basis or when payment is for services furnished by a participating physician or supplier, a patient’s signature or a “signature on file” is not required in order for Medicare payment to be made directly to the physician or supplier.”

Regardless of the wording on these instructions stating that it authorizes payments to the physician, this is not enough to ensure that payment will come directly to you instead of the patient.To guarantee payment comes to you, you MUST accept assignment.

Under Medicare rules, PARTICIPATING providers are paid at 80% of the  physician fee schedule allowed amount  and NON-participating providers are paid at 80% of the allowed amount, which is 5% less than the full Allowed amount for participating providers. Only NON-participating providers may "balance bill" the patient for any amounts not paid by Medicare, however, they are subject to any state laws regarding balance billing.

TIP: If you select YES, you may or may not be subject to a lower fee schedule, but at least you know the payment is  supposed  to come to you.

NON-MEDICARE Instructions / Guidelines

PARTICIPATING providers MUST abide by the terms of their contract.  In most cases, this includes the requirement to accept assignment on submitted claims.

NON-PARTICIPATING providers have the choice to accept or not accept assignment.

YES means that payment should go directly to you instead of the patient.  Generally speaking, even if you have an assignment of benefits from the patient (see box 12 & 13), payment is ONLY guaranteed to go to you IF you accept assignment.

NO is appropriate for patients who have paid for their services in full so they may be reimbursed by their insurance.  It generally means payment will go to the patient.

What Does Accept Assignment Mean?. (2014, August 1). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/what-does-accept-assignment-mean-34840.html

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As a Medical Biller, the better you understand the medical insurance payment process, the better you can care for your patients. Your understanding of what a patient will owe and what will be covered can help them navigate the confusing world of medical insurance.

One term that can be very confusing for patients (and for doctors as well) is ‘Accepting Assignment’.

Essentially, ‘assignment’ means that a doctor, (also known as provider or supplier) agrees (or is required by law) to accept a Medicare-approved amount as full payment for covered services.

This amount may be lower or higher than an individual’s insurance amount, but will be on par with Medicare fees for the services.

If a doctor participates with an insurance carrier, they have a contract and agree that the provider will accept the allowed amount, then the provider would check “yes”.  

If they do not participate and do not wish to accept what the insurance carrier allows, they would check “no”.   It is important to note that a provider who does not participate can still opt to accept assignment on just a particular claim by checking the “yes” box just for those services.

In other words by saying your office will accept assignment, you are agreeing to the payment amount being covered by the insurer, or medicare, and the patient has no responsibility.

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accept an assignment

Accepting a patient care assignment reaffirms nurses’ contract with society

At the moment a patient handoff is nearly completed, when the exchange of relevant information has occurred and when the opportunity for final clarification of the patient condition and situation has passed, an act that has not received much attention occurs. It is the act of the nurse accepting the patient care assignment . Here’s a closer look at some of the implications of that act.

Accepting responsibility

A patient handoff has been defined as the process of transferring primary authority and responsibility for providing care to a patient from one departing caregiver to one oncoming caregiver. The moment when the nurse accepts the assignment may have some type of organizational ceremony such as applying one’s signature to a form, handing over the unit keys, or simply telling the person ending his or her shift to have a good rest of the day.

Accepting an assignment has most often been discussed in the context of the nurse’s right to refuse an assignment. Regulatory agencies offer guidelines and decision-making trees to help nurses determine their knowledge, skills, and abilities when they have concerns with a patient care assignment. The American Nurses Association’s (ANA’s) position statement “Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment,” supports the RN’s rights and responsibilities for refusing a patient care assignment. Refusing an assignment can become quite entangled ethically and legally, and may entail consequences that can be personally devastating for the nurse. Once a patient care assignment is accepted, refusal to care for a patient may lead to charges of abandonment.

Thus, the act of accepting the patient care assignment needs to have proper attention and significance attached. Accepting an assignment is the nurse’s declaration and acceptance of responsibility for the patient(s). It is a sacred act that occurs hundreds of thousands of times a day, sometimes done unconsciously, without the awareness that from this point forward the receiver is expected to meet the standards of practice and standards of performance, adhere to the code of ethics, and reaffirm the contract nursing has made with society. It is the moment when the receiver promises to provide competent nursing care by using the nursing process as outlined by ANA: assess and collect comprehensive data about the patient and situation; analyze the assessment data to determine a diagnosis; identify expected outcomes individualized to each patient; develop a plan that sets down strategies to attain those expected outcomes; implements the plan developed with the patient/family; and evaluate the progress made toward outcomes.

The receiver also promises to act in a competent professional manner: practice ethically by adhering to the Code of Ethics; keep up to date in one’s chosen field of nursing practice; integrate evidence and research findings into practice; contribute to quality nursing practice; demonstrate leadership; collaborate with the health care team; evaluate one’s own practice in relation to professional practice standards, guidelines, rules, and regulations; use appropriate, safe, efficient, and effective resources in the provision of nursing care; and practice in a safe and healthy manner.

Reaffirming our commitment

Every handoff affords the opportunity to reaffirm one’s commitment to the practice of nursing as described in “Nursing’s Social Policy Statement.” It reminds us of the meaning and purpose of nursing. Accepting the assignment is affirmation of our vow to protect, promote, and optimize health and abilities; prevent illness and injury; alleviate suffering through diagnosis and treatment of human responses; and advocate in the care of individuals, families, communities, and populations. It affords us a moment to pause and to reaffirm our contract with society.

Selected references

American Nurses Association. Position Statement: Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment. March 12, 2009. http://nursingworld.org/rnrightsps

American Nurses Association. Nursing’s Social Policy Statement . Silver Springs, MD: nursesbooks.org; 2010.

Cohen MD, Hilligoss BP. Handoffs in Hospitals: A review of the literature on information exchange while transferring patient responsibility or control. University of Michigan. http://deepblue.lib.umich.edu/bitstream/2027.42/61498/1/Handoffs_in_Hospitals_Literature_Review_081014.pdf

Friesen M, White SV, Byers JF. (2008). Chapter 34 Handoffs: Implications for Nurses in Patient Safety and Quality: An Evidence-Based Handbook for Nurses .

Thomas L, Donohue-Porter P. Blending evidence and innovation: improving intershift handoffs in a multihospital setting. J Nurs Care Qual . 2012;27(2):116-24.

Department of Veterans Affairs. VHA Nursing Hand-Off Survey. December 2006. http://www.va.gov/NURSING/docs/Final_VHA_Nursing_HandOff06_Report.pdf

Becky Graner is a nurse consultant in Mandan, North Dakota.

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What does it mean to accept assignment on the CMS 1500 claim form – also called the HCFA 1500 claim form.? Should I accept assignment or not? What are the guidelines for accepting assignment in box 27 of the 1500 claim?

These commonly asked questions should have a simple answer, but the number of court cases indicates that it is not as clear cut as it should be. This issue is documented in the book “Problems in Health Care Law” by Robert Desle Miller. The definition appears to be in the hands of the courts. However, we do have some helpful guidelines for you.

One major area of confusion is the relationship between box 12, box 13 and box 27.  These are not interchangeable boxes and they are not necessarily related to each other.

According to the National Uniform Claim Committee (NUCC), the “Accept Assignment” box indicates that the provider agrees to accept assignment.  It simply says to enter an X in the correct box.  It does NOT define what accepting assignment might or might not mean.

It is important to understand that if you are a participating provider in any insurance plan or program, you must first follow the rules according to the contract that you sign. That contract superceeds any guidelines that are included here.

Medicare Instructions / Guidelines

PARTICIPATING providers MUST accept assignment according to the terms of their contract.  The contract itself states:

“Meaning of Assignment – For purposes of this agreement, accepting assignment of the Medicare Part B payment means requesting direct Part B payment from the Medicare program.  Under an assignment , the approved charge, determined by the Medicare carrier, shall be the full charge for the service covered under Part B.  The participant shall not collect from the beneficiary or other person or organization for covered services more than the applicable deductible and coinsurance.”

By law, the providers or types of services listed below MUST also accept assignment:

  • Clinical diagnostic laboratory services;
  • Physician services to individuals dually entitled to Medicare and Medicaid;
  • Services of physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, certified registered nurse anesthetists, clinical psychologists, and clinical social workers;
  • Ambulatory surgical center services for covered ASC procedures;
  • Home dialysis supplies and equipment paid under Method II;
  • Ambulance services;
  • Drugs and biologicals; and
  • Simplified Billing Roster for influenza virus vaccine and pneumococcal vaccine.

NON-PARTICIPATING providers can choose whether to accept assignment or not, unless they or the service they are providing is on the list above.

The official Medicare instructions regarding Boxes 12 and 13 are:

“Item 12 – The patient’s signature authorizes release of medical information necessary to process the claim. It also authorizes payments of benefits to the provider of service or supplier when the provider of service or supplier accepts assignment on the claim.” “Item 13 – The patient’s signature or the statement “signature on file” in this item authorizes payment of medical benefits to the physician or supplier. The patient or his/her authorized representative signs this item or the signature must be on file separately with the provider as an authorization. However, note that when payment under the Act can only be made on an assignment-related basis or when payment is for services furnished by a participating physician or supplier, a patient’s signature or a “signature on file” is not required in order for Medicare payment to be made directly to the physician or supplier.”

Regardless of the wording on these instructions stating that it authorizes payments to the physician, this is not enough to ensure that payment will come directly to you instead of the patient.To guarantee payment comes to you, you MUST accept assignment.

Under Medicare rules, PARTICIPATING providers are paid at 80% of the physician fee schedule allowed amount and NON-participating providers are paid at 80% of the allowed amount, which is 5% less than the full Allowed amount for participating providers. Only NON-participating providers may “balance bill” the patient for any amounts not paid by Medicare, however, they are subject to any state laws regarding balance billing.

NON-MEDICARE Instructions / Guidelines

PARTICIPATING providers MUST abide by the terms of their contract.  In most cases, this includes the requirement to accept assignment on submitted claims.

NON-PARTICIPATING providers have the choice to accept or not accept assignment.

YES means that payment should go directly to you instead of the patient.  Generally speaking, even if you have an assignment of benefits from the patient (see box 12 & 13), payment is ONLY guaranteed to go to you IF you accept assignment.

NO is appropriate for patients who have paid for their services in full so they may be reimbursed by their insurance.  It generally means payment will go to the patient.

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  • RNformation (Nevada) August 2015 issue is now available.

Understanding Unsafe Nursing Assignments

Understanding Unsafe Nursing Assignments

This article appears on page 13 of

RNformation (Nevada) August 2015

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Nurses are accountable for the quality of care they deliver and have a duty to recognize their own personal and professional limitations before accepting a patient assignment. When presented with potentially unsafe assignments, nurses often accept these assignments without question. Whether this is due to feelings of powerlessness or fear of disciplinary actions, the fact remains that nurses are responsible for the care they provide after accepting the assignments. There is no ideal choice in these situations, so nurses should collaborate with other professionals prior to accepting the assignment.

Unsafe assignments may evolve from inadequate staffing or training, fatigue, or lack of experience. Since accepting an unsafe assignment could be viewed as unprofessional conduct in some cases, it is important that nurses collaborate with colleagues and other professionals to address the personal and professional risks inherent in unsafe assignments. The Code of Ethics for Nurses with Interpretive Statements (2015), also called “The Code,” is a guide that should be used when faced with difficult choices. There are nine “nonnegotiable” provisions that address “ethical values, obligations, duties and ideals” related to nursing practice (p. viii).

Regulation versus Organizational Support The concern for safe patient care has resulted in legislative and regulatory action across the nation. The historic passage of Senate Bill 362 has strengthened the staffing requirements in Nevada (Spearman, 2013). In addition to having a sufficient number of nurses available to care for patients, nurses must also recognize that an appropriate skill mix of RNs is needed to achieve a safe and professional nursing practice environment (ANA, 2012). Because nurses are accountable for the quality of care they deliver, each nurse has a duty to recognize personal limits and to advocate for a safe and professional work environment. These actions are aligned with the ethical principle of beneficence, which requires nurses to actively safeguard patients by doing something good or that provides benefit. Provision 5.1 of The Code speaks to moral respect and how it needs to be extended to everyone, including patients, co-workers, and oneself. Therefore, if an assignment is beyond the capabilities of a nurse, for any reason, all nurses have a duty to speak up and advocate for a safe practice environment.

Ulrich, et al. (2010) studied the frequency of stress related to ethical issues that nurses encountered in their daily practice. Staffing patterns were among the top five most stressful patient care issues and 1/3 of the nurses reported that staffing problems led to frequent stress. An alarming 44% of the respondents reported being tired at work (2010). The ANA issued a Position Statement on the topic of nurse fatigue in 2014. The Position statement includes evidence-based recommendations such as involving nurses in the design of staffing plans and not using mandatory overtime as a “staffing solution.” Nursing leaders must engage in and encourage a peer review process to address situations that threaten the fundamental values and safety of nursing practice.

What Happens When Presented with an Unsafe Assignment? The ANA and NNA have taken a strong position to support nurses who, in good faith, choose not to accept an assignment that compromises patient safety or professional values. Professional organizations help to affirm, strengthen, and communicate professional values so that they remain “steadfast and unwavering,” (The Code, p. 35). Nurses are encouraged to use resources, such as Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses (2015), to begin conversations among colleagues and supervisors about the issue of unsafe assignments.

When presented with an unsafe assignment that cannot be accepted in good faith, the nurse should negotiate with a supervisor to identify a modified or an alternative assignment. If an agreement cannot be reached, then the nurse needs to professionally refuse the unsafe assignment (ANA, 2012) by following the organization’s policy. A description of any good faith attempts to negotiate an alternative solution should be included.

Nurses may be directed to complete an “Assignment Despite Objection” (ADO) form instead of refusing an assignment. The ADO may be useful when objecting to an assignment that can be accepted in good faith, while acknowledging that the provision of care may not reflect best practice or what “ought to be.” Provision 6.3 of The Code describes the appropriateness of “collective and inter-professional efforts to address conditions of employment,” (p. 24). Unless the ADO form has an area to refuse an unsafe assignment in good faith, it should be used to document potentially unsafe practices that will inform leadership and peers that the practice environment is not ideal and ought to change. Completing the form will not relieve the individual nurse of the responsibility for adverse patient outcomes if the assignment is accepted.

Final Thoughts Nurses are expected to have the skills, capabilities, competencies, knowledge, and resources necessary to provide the care required for each patient, or aspect of care, they accept. Providing a timely notice when an assignment cannot be accepted is necessary to maintain a collegial and professional practice environment. It takes courage to engage in these difficult conversations, but if an assignment is unsafe, nurses have a duty to communicate their intentions in a timely manner so that appropriate measures may be identified. Through active involvement with staffing initiatives and the development of processes that appropriately address unsafe assignments, together nurses may be able to create a safe and professional nursing practice environment.

Bibliography ANA (2014, Nov. 19). ANA calls for stronger collaboration between RNs, employers to reduce risks from nurse fatigue. Retrieved from www.nursingworld.org ANA (2012). ANA’s Principles for Nurse Staffing, 2nd Ed. ANA: Silver Spring, MD ISBN- 13: 978-1-55810-443-2 ANA (2015). Questions to ask in making the decision to accept a staffing assignment for nurses. Workplace Advocacy. Retrieved from www.nursingworld.org Code of Ethics for Nurses with Interpretive Statements (2015). ANA: Silver Spring MD. Retrieved from www.nursingworld.org Spearman, P. (2013, August). Senate bill 362 Empowerment by design: Utilizing staffing committees to improve patient care. RNformation (Nevada). Retrieved from http://www.nursingald.com Ulrich, C.M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday ethics: ethical issues and stress in nursing practice. Journal of Advanced Nursing 66(11), 2510–2519. doi: 10.1111/j.1365-2648.2010.05425.x

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How To Refuse an Unsafe Patient Assignment as a Nurse

What is a safe nursing assignment, when should you refuse an assignment, how to refuse a patient assignment.

How To Refuse an Unsafe Patient Assignment as a Nurse

You walk into work, ready to spend the next 12 hours taking care of your patients and providing them with the best nursing care possible.  You look at your patient assignment and see you have one extra patient than usual, as well as only one CNA for your entire nursing unit.  Your charge nurse has a full patient assignment too, making her less available to offer help and support.  You hear machines beeping, bed alarms sounding, and patients yelling, and you stop and think to yourself “is this safe?”

Does this scenario sound familiar to you as a nurse?  

Being given an inappropriate assignment can be very overwhelming and stressful.  Your patients need you to show up and take care of them, and your nursing team needs you, and you want to help.

But where do you draw the line, and say “NO”, to a patient assignment?  What is an unsafe assignment, and can a nurse refuse an assignment?

An appropriate nursing assignment is any patient assignment where the nurse can safely and effectively provide all the necessary care for their patients, and have the necessary tools, training, medications, knowledge, resources, and equipment to perform their nursing duties for those patients.

The definition of a safe and appropriate nursing assignment is variable, has to do with much more than patient ratios alone, and will vary by state and facility.

Per the American Nurses Association (ANA), nurses have not only a right but also an obligation to assess and determine if they can safely and appropriately provide care on any given patient assignment.  They provide this list of questions that every nurse should be asking themselves before accepting any patient assignment.

What does an inappropriate or unsafe patient assignment look like, and what are some reasons you might stop and consider refusing the assignment or asking your leader for changes to the assignment?

Too Many Patients

There are only 2 states in the US that have laws mandating nurse-to-patient ratios , California and Massachusetts.  Some states, but not all of them, have mandatory reporting requirements for staffing.  Others have staffing committees with some nurse members to assist in making staffing decisions, but still no mandated ratios.

You will learn as you gain more nursing experience how many patients are too much for you as one nurse.  This will depend on your unit’s acuity level, patient population, and the individual staffing policies at your facility.

  • Inappropriate distribution of patient acuity

5 “walkie-talkie” patients are vastly different from 5 patients on high-level oxygen.  The ability to understand what constitutes high acuity will also come with more nursing experience.  You may not know or understand, what the acuity level is of a COVID patient on continuous BIPAP, until you have cared for that type of patient.

Also take into consideration how many discharges or empty rooms you have, if you have any patients on continuous drips or pain pumps, your patient’s mobility level, and if your patient is scheduled for any procedure that will warrant intense post-procedure monitoring when they return.

A particular patient’s acuity can change with each shift, which means nursing management must be in close communication with the team and get accurate patient acuity updates before making each assignment.

Inadequate knowledge or training

Are you being asked to care for a post-surgical patient on gynecology, when you normally take care of patients recovering from a stroke?  Are you being asked to care for pediatric patients when you have only ever cared for adults?  Maybe you are being asked to do something you think may be out of your scope of practice as a nurse.  This would be a reason to voice concern and ultimately refuse a particular assignment.

No Supplies or Help

Do you have all of the equipment you need to do your job?  Do you know where your code cart is, and can you safely and effectively help your patient in an emergency?  Are your medications stocked, machines in good working order, and can you get extra help if you need it?

If you don’t have all of the above, keeping your patients safe could be a challenge, and this alone would deem your assignment unsafe.

If you find yourself in any of the above situations, or others in which you feel your license and patient safety are in jeopardy,  can you refuse to take the assignment ?

The ANA upholds that “ registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm.”  Read the full ANA position statement here.

It is not only your right as a nurse, but also your duty, to raise concern and ultimately refuse an unsafe, inappropriate assignment.  Here are some tips on how you can bring up these concerns and refuse your assignment as a nurse.

Know your rights, and be prepared to state them

It is solely your responsibility as a nurse to know your rights, as well as your responsibilities, in the state in which you practice as a nurse. Each state has its own Nurse Practice Act, which defines by law what you can, and cannot do, as a nurse.  It also contains your nursing scope of practice.   Visit the NCSBN website to quickly navigate to each state's Nurse Practice Act .

The NCSBN also provides a great decision-making tool to help explain the proper process of determining whether or not a certain activity is within the nurse’s scope.

Be prepared to refer to the Nursing Code of Ethics , and verbalize any statement of your nursing rights when communicating about your patient assignment with your leader.  By knowing your rights as a nurse, and being ready to state them, you can clearly and effectively communicate with your manager why you want to refuse an assignment when placed in an unsafe situation.

Don’t Create a Nurse-Patient Relationship

Before you decide to accept any patient assignment, you need to avoid any activity that could be considered creating a nurse-patient relationship.  There is a fine line between refusing a patient assignment, and nurse abandonment, which also varies state by state.  

For example in Arizona, the board of nursing defines patient abandonment as a nurse severing or ending the nurse-patient relationship, after creating the relationship, without giving handoff or reporting to another capable nurse to take over that patient's care.

Here are some things that may be considered for establishing a nurse-patient relationship:

Viewing the patient’s electronic medical record

Saying hi to the patient, or going into their room at all

Taking orders from a doctor regarding that patient

Administering any type of patient care such as assisting them to the bathroom, taking them a food tray, or administering them any medications.

It is critical to read up on your state’s Nurse Practice Act and get a very clear definition of what patient abandonment is in your state.  Your state’s board of nursing will have the resources needed to give you directions on the correct process of refusing an assignment in your state of licensure.

Do Your Research and Be Prepared

Nurses are always thinking ahead, preparing for what can go wrong with our patients, and ready to act in case of any emergency.  We know exactly what equipment we will need for our patients, and would never allow our patients to be without adequate IV access.

Apply this same principle to the safety of your nursing license, your patients, and your team, by doing your research on the process of refusing a patient assignment correctly.  Study your facilities policies, your nursing rights, and your state’s Nurse Practice Act.

It is your responsibility to know these things, and you don’t want to be scrambling at the very last second trying to do this research when you are being pressured at the moment to take a dangerous assignment.

Keep Everything in Writing

If you do end up voicing any sort of staffing or patient safety concerns, or ultimately refusing an assignment, always make sure you are communicating it to all of the appropriate leaders and follow your chain of command.

Send an email to all members of your leadership team to summarize the situation, and provide thorough documentation of why you are refusing an assignment, with adequate details.

Keep any paper records for yourself, just in case.

Help Find Solutions

Refusing a patient assignment will have an impact on all of the patients in the unit, the entire hospital, as well as the rest of the members of the healthcare team.  It is your right, and duty, to refuse an inappropriate assignment.  But try to be as professional and flexible as possible, keeping the ultimate goal of patient safety in mind.

Can you and your team brainstorm with your nursing leader on other ways to make everyone’s assignments safe and appropriate, such as:

Calling in a resource RN to help with patient care tasks

Re-arranging the patient assignment to re-distribute patient acuity better among all nurses

Obtaining a 1:1 sitter for all confused patients, ensuring their safety and also freeing up your extra time for your other patients?

Better assigning the patients to nurses based on their appropriate certifications, and expertise?

Ultimately you are a team, and you are there for your patients and each other.  The goal is patient safety, and if you don’t speak up and refuse to take an inappropriate assignment, your patient’s well-being and your nursing license are on the line.  

Be prepared to have these conversations, and be well-versed in your rights as a nurse.  By refusing inappropriate assignments, you are advocating for yourself, and your patients, and being a voice for positive change in healthcare.

Amy McCutcheon

Amy was surgical PCU/Telemetry unit as a new grad for over 10 years; the last year and a half of that time being Telemetry COVID nursing. She stepped away from the bedside and is currently working PRN as a concierge nurse. Amy has a passion for budgeting. Follow her on Instagram, Facebook, and on her website Real Desert Mama , where she talks about budgeting, saving money, and tips and motivation on how to live a great life and achieve your financial goals through budgeting

14 CFR § 121.471 - Flight time limitations and rest requirements: All flight crewmembers.

(a) No certificate holder conducting domestic operations may schedule any flight crewmember and no flight crewmember may accept an assignment for flight time in scheduled air transportation or in other commercial flying if that crewmember 's total flight time in all commercial flying will exceed—

(1) 1,000 hours in any calendar year;

(2) 100 hours in any calendar month;

(3) 30 hours in any 7 consecutive days;

(4) 8 hours between required rest periods.

(b) Except as provided in paragraph (c) of this section, no certificate holder conducting domestic operations may schedule a flight crewmember and no flight crewmember may accept an assignment for flight time during the 24 consecutive hours preceding the scheduled completion of any flight segment without a scheduled rest period during that 24 hours of at least the following:

(1) 9 consecutive hours of rest for less than 8 hours of scheduled flight time .

(2) 10 consecutive hours of rest for 8 or more but less than 9 hours of scheduled flight time .

(3) 11 consecutive hours of rest for 9 or more hours of scheduled flight time .

(c) A certificate holder may schedule a flight crewmember for less than the rest required in paragraph (b) of this section or may reduce a scheduled rest under the following conditions:

(1) A rest required under paragraph (b)(1) of this section may be scheduled for or reduced to a minimum of 8 hours if the flight crewmember is given a rest period of at least 10 hours that must begin no later than 24 hours after the commencement of the reduced rest period .

(2) A rest required under paragraph (b)(2) of this section may be scheduled for or reduced to a minimum of 8 hours if the flight crewmember is given a rest period of at least 11 hours that must begin no later than 24 hours after the commencement of the reduced rest period .

(3) A rest required under paragraph (b)(3) of this section may be scheduled for or reduced to a minimum of 9 hours if the flight crewmember is given a rest period of at least 12 hours that must begin no later than 24 hours after the commencement of the reduced rest period .

(4) No certificate holder may assign, nor may any flight crewmember perform any flight time with the certificate holder unless the flight crewmember has had at least the minimum rest required under this paragraph.

(d) Each certificate holder conducting domestic operations shall relieve each flight crewmember engaged in scheduled air transportation from all further duty for at least 24 consecutive hours during any 7 consecutive days.

(e) No certificate holder conducting domestic operations may assign any flight crewmember and no flight crewmember may accept assignment to any duty with the air carrier during any required rest period .

(f) Time spent in transportation, not local in character, that a certificate holder requires of a flight crewmember and provides to transport the crewmember to an airport at which he is to serve on a flight as a crewmember , or from an airport at which he was relieved from duty to return to his home station, is not considered part of a rest period .

(g) A flight crewmember is not considered to be scheduled for flight time in excess of flight time limitations if the flights to which he is assigned are scheduled and normally terminate within the limitations, but due to circumstances beyond the control of the certificate holder (such as adverse weather conditions), are not at the time of departure expected to reach their destination within the scheduled time.

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COMMENTS

  1. Does your provider accept Medicare as full payment?

    claim directly to Medicare and can't charge you for submitting the claim. How does assignment impact my drug coverage? Find out if your doctors and other health care providers accept assignment or participate in Medicare. Using a provider that doesn't accept Medicare as full payment

  2. Medicare Assignment: What It Is and How It Works

    Medicare assignment is an agreement between Medicare and medical providers (doctors, hospitals, medical equipment suppliers, etc.) in which the provider agrees to accept Medicare's fee schedule as payment in full when Medicare patients are treated.

  3. Questions to Ask in the Decision to Accept Assignments

    Good-faith acceptance of an assignment means that you are concerned about the situation and believe that a different pattern of care or policy should be considered.

  4. What Is Medicare Assignment and How Does It Affect You?

    All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies, without paying a deductible or coinsurance if the provider accepts assignment.

  5. What Does Accept Assignment Mean?

    According to the National Uniform Claim Committee (NUCC), the "Accept Assignment" box indicates that the provider agrees to accept assignment. It simply says to enter an X in the correct box. It does NOT define what accepting assignment might or might not mean.

  6. PDF Accepting, Rejecting & Delegating a Work Assignment

    nurses as it relates to accepting, rejecting or delegating a work assignment. • Provide a framework for the nurse's decision to accept, ne-gotiate, or reject a work assignment and to delegate nurs-ing acts. • Outline a process for evaluating the appropriateness of a work assignment and the delegation of a nursing task. Statement of Problem

  7. PDF GUIDELINES FOR THE REGISTERED NURSE Giving, Accepting, or ...

    this rule to pressure them into accepting an assignment the nurse feels is unreasonable or unsafe. However, NCQAC's policy states that abandonment occurs only when the nurse willfully leaves an assignment he or she has accepted without transferring responsi - bility to appropriate personnel (see Appendix V). Liability for Nurses

  8. liveClinic MyRecords

    Essentially, 'assignment' means that a doctor, (also known as provider or supplier) agrees (or is required by law) to accept a Medicare-approved amount as full payment for covered services. This amount may be lower or higher than an individual's insurance amount, but will be on par with Medicare fees for the services.

  9. Assignment and Nonassignment of Benefits

    It is possible for a physician/supplier to accept assignment on a partially paid bill. In this case the physician/supplier still must accept Medicare's allowed amount as their payment in full.

  10. Accepting a patient care assignment reaffirms nurses' contract with society

    Accepting the assignment is affirmation of our vow to protect, promote, and optimize health and abilities; prevent illness and injury; alleviate suffering through diagnosis and treatment of human responses; and advocate in the care of individuals, families, communities, and populations.

  11. Medicare Assignment

    When Medicare assignment is accepted, it means your doctor agrees to the payment terms of Medicare. Doctors that accept Medicare assignment fall under one of three designations: a participating doctor, a non-participating doctor, or they opt-out of the program altogether.

  12. Rights of RNs When Considering a Patient Assignment

    The American Nurses Association (ANA) upholds that registered nurses - based on their professional and ethical responsibilities - have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.

  13. What Does Accept Assignment Mean?

    What Does Accept Assignment Mean? What does it mean to accept assignment on the CMS 1500 claim form - also called the HCFA 1500 claim form.? Should I accept assignment or not? What are the guidelines for accepting assignment in box 27 of the 1500 claim?

  14. Safe Harbor and Resilience

    Nurses can invoke safe harbor, in good faith, to protect their licenses if they find themselves in compromised practice situations where it is not in the best interest of patients for them to accept an assignment, e.g. working mandatory overtime, accepting expanded patient assignments, etc. And now nurses can also use oral safe harbor when they ...

  15. Understanding Unsafe Nursing Assignments

    Since accepting an unsafe assignment could be viewed as unprofessional conduct in some cases, it is important that nurses collaborate with colleagues and other professionals to address the personal and professional risks inherent in unsafe assignments. The Code of Ethics for Nurses with Interpretive Statements (2015), also called "The Code ...

  16. When to Refuse a Nursing Assignment

    If the procedure cannot be delayed and there's no one else available to handle it, however, consider accepting the assignment.

  17. How To Refuse an Unsafe Patient Assignment as a Nurse

    7 Min Read Published November 4, 2022 What is a Safe Nursing Assignment? When Should you Refuse an Assignment? How to Refuse a Patient Assignment You walk into work, ready to spend the next 12 hours taking care of your patients and providing them with the best nursing care possible.

  18. PDF ACCEPTING AN ASSIGNMENT

    ACCEPTING AN ASSIGNMENT POSITION STATEMENT for RN and LPN Practice P.O. BOX 2129 - Raleigh, NC 27602 (919) 782-3211 - FAX (919) 781-9461 Nurse Aide II Registry (984) 238-7697 www.ncbon.com Statements address issues of concern to the Board relevant to protection of the public and are reviewed

  19. accept assignment

    If you accept assignment you can bill the patient the $50 difference between the $200 ALLOWED amount and the $150 payment. A non-par provider doesn't have a contract so they can bill the patient the difference between the billed amount and the payment received ($300-$200 = $100) since there is no contract stating they will accept a reduced rate ...

  20. PDF Safe Harbor (SH): Key Points Included in the resource

    Proceed with accepting the assignment OR see decision tree for accepting an assignment. Refuse to accept the Nurse receives patient assignment OR Assignment changes during shift. Complete and submit a comprehensive written request to the nurse supervisor. Complete and submit a comprehensive written request to the nurse supervisor. INVOKE SHNPR and

  21. How do I accept an assignment?

    It's simple! There are several ways to accept an assignment - and it depends on how the MSP published it. Most assignments are available to self-assign (you can grab it if you want it) and others must be requested (a scheduler decides who gets it). Self-Assigning. Whether you are using the website or an iSecretShop smartphone app, click ...

  22. 14 CFR § 121.471

    (a) No certificate holder conducting domestic operations may schedule any flight crewmember and no flight crewmember may accept an assignment for flight time in scheduled air transportation or in other commercial flying if that crewmember's total flight time in all commercial flying will exceed— (1) 1,000 hours in any calendar year; (2) 100 hours in any calendar month;

  23. 14 CFR Part 135 Subpart F

    ( a) A certificate holder may assign a flight crewmember and a flight crewmember may accept an assignment for flight time only when the applicable requirements of §§ 135.263 through 135.271 are met. ( b) No certificate holder may assign any flight crewmember to any duty with the certificate holder during any required rest period.