Question

multiple choice question

nonparticipating physicians usually do not accept assignment or file the claim on a patients behalf except for ______.

consumer driven health plans
hmos
medicare
epos

Explanation:

Analyze the rules for nonparticipating providers

Using the Nonparticipating Providers and Accepting Assignment knowledge points

Under federal guidelines, nonparticipating (non-PAR) providers generally do not accept assignment (meaning they do not agree to accept the insurance contract's allowed charge as payment in full) and do not file claims on behalf of patients. However, Medicare is a major exception to this rule. Even if a physician is nonparticipating in Medicare, federal law requires them to submit Medicare claims on behalf of Medicare beneficiaries for covered services.

Evaluate the given options

• Consumer driven health plans: Non-PAR providers are not legally mandated to file claims or accept assignment for these commercial plans.
• HMOs: Health Maintenance Organizations typically require participating network providers; non-PAR providers do not have to file claims for them.
• Medicare: Federal law mandates that all physicians and suppliers (participating or nonparticipating) must file claims for Medicare beneficiaries for covered services.
• EPOs: Exclusive Provider Organizations do not mandate non-PAR claim filing.

Answer:

• Consumer driven health plans
• HMOs
• Medicare (Correct answer)
• EPOs