The process by which a hospital or physician requests payment from a patient’s insurance company for medical services. lasik eye surgery is usually completed in the form of an Assignment of Benefits (AOB). It is a written authorization from the patient or guarantor that grants permission to release information required for reimbursement.
When a patient signs a release of information and an assignment of benefits?
An agreement between Medicare beneficiaries, physicians or suppliers and MACs whereby the beneficiary agrees to allow the physician or supplier to request direct payment from Medicare for Part B covered services, equipment and supplies. The physician/supplier may not charge the beneficiary more than the Medicare allowed payment amount determined by the MACs. A physician/supplier who agrees to accept assignment for all services furnished on a claim-by-claim basis is known as a participating physician/supplier.
A physician/supplier who has accepted assignment of a patient’s supplemental insurance is in violation of their assigned benefits agreement if they bill the enrollee and/or the private insurer any amount which, when added to the Medicare allowed payment amount received from a carrier, exceeds the Medicare allowed amount. If it comes to the MACs attention that an assignee has violated this requirement, they may refund the excess amount to the enrollee.
In order for a provider to properly complete their AOB, they must ensure that they include the proper business name in the form. While this may seem simple enough, a wrong business name can lead to confusion and even an argument in court that the AOB was not validly executed. In addition, it is also important to include the power of attorney language within the AOB that supports the legal right to pursue all available remedies. The team at Callagy Law can assist in preparing and reviewing your AOBs as well as other admission paperwork to help ensure that you are receiving maximum reimbursement on all recoverable bills.