Injectable drugs and their administration are subject to limitation of liability and refund requirements for services rendered on or after March 1, 1998. The assignment of the claim determines whether this applies to only the drug or the drug and its administration.
Assigned Claims
Limitation of liability applies to injectable drugs and their administration when denied as not being reasonable and necessary.
Non-assigned Claims
Only physician services submitted on non-assigned claims by nonparticipating providers are subject to refund requirements.
Exception: When flu, pneumococal, or hepatitis B injections are submitted on non-assigned claims by non-participating providers, neither the administration nor the drug itself constitute physician services so refund requirement does not apply.
Mandatory Assignment Required
Under the Benefits Improvement and Protection Act of 2000 (BIPA), payment for any drug or biological covered under Part B of Medicare must be made only on an assignment basis. Therefore, no charge or bill may be rendered to anyone for drugs and biologicals for any amount except the Medicare Part B deductible and coinsurance amounts.
Effective July 1, 2001, for dates of service on or after February 1, 2001, physicians and non-physicians practitioners must accept assignment on claims for drugs and biologicals.
Claims submitted as 'Unassigned' ('N' in the assignment field of electronic claims or Item 27 of the CMS-1500 claim form marked 'No') or when assignment is not indicated, will be processed as follows:
- If the only services on the claim are drugs and biologicals, the claim assignment will be changed to Assigned
- If the claim contains drugs and biologicals, in addition to other services, the drugs and biologic biologicals will be split onto a separate claim and processed as Assigned
Your remittance notice will reflect the following remark code if the claim assignment was changed:
N71: Your assigned claim for a drug or biological was processed as an assigned claim. The law requires that you must take assignment on all claims for drugs and biologicals.