Which statement regarding nonparticipating physician providers under Medicare Part B is FALSE?

Prepare for the RHIA Reimbursement Test with multiple choice questions, each accompanied by hints and explanations. Ace your exam with confidence!

The statement regarding nonparticipating physician providers under Medicare Part B that is false is that nonparticipating providers have a higher fee schedule than participating providers.

Nonparticipating providers, by definition, do not accept the Medicare-approved amount as full payment for their services. They have the option to charge patients higher fees, but these fees cannot exceed a specific limit known as the “limiting charge.” In contrast, participating providers agree to accept the Medicare fee schedule as payment in full, which typically results in lower out-of-pocket costs for patients. Therefore, the fee schedule for nonparticipating providers is generally lower than that for participating providers.

In contrast, the other statements are accurate. Nonparticipating providers must indeed file their own Medicare claims for the services they render, have restrictions on how much they can charge above the Medicare-approved amount, and collections for assigned claims are specifically limited to the deductible and coinsurance amounts due at the time of service. This ensures a clear understanding of the payment responsibilities for patients and the obligations for providers.

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