How does a provider receive payment if they do not accept assignment on a $480 bill with Medicare approving $400?

When a provider does not accept assignment for Medicare services, they retain the right to charge their patient a higher fee than what Medicare approves. In this scenario, since Medicare has approved $400 of the $480 bill, the provider can still bill the patient for the difference.

The "limiting charge" is the maximum amount that a non-participating provider can charge a beneficiary for a service after Medicare has approved a lower amount. In this case, the provider can charge the patient the approved amount ($400) plus any additional amount up to the limiting charge on that approved service. This means that while the provider will receive payment from Medicare, the total payment they receive will also include what the patient pays to meet the limiting charged amount.

Therefore, the provider receives payment from Medicare for the approved amount and can charge the patient for any additional amount permissible under the limiting charge, ensuring they are compensated appropriately for their services while also complying with Medicare regulations.