CMS Pub. 100-04, ch. 16, § 30.1

B3-5114.1

Unless a laboratory, physician, or medical group accepts assignment, the A/B MAC (B) makes no Part B

payment for laboratory tests paid on the laboratory fee schedule. Laboratories, physicians, or medical groups

that have entered into a participation agreement must accept assignment. Sanctions of double the violation

charges, civil money penalties (up to $2,000 per violation), and/or exclusion from the program for a period of

up to five years may be imposed on physicians and laboratories, with the exception of rural health clinic

laboratories, that knowingly, willfully, and repeatedly bill patients on an unassigned basis. However, sole

community physicians and physicians who are the sole source of an essential specialty in a community are not

excluded from the program. Whenever a A/B MAC (B) is notified of a sanction action for this reason, the A/B

MAC (B) does not pay for any laboratory services unless the services were furnished within 15 days after the

date on the exclusion or suspension notice to the practitioner, and:

• It is the first claim filed for services rendered to that beneficiary after the date on the notice of

suspension or exclusion; or

• It is filed with respect to services furnished within 15 days of the date on the first notice of denial of

claims to the beneficiary. (Fifteen days are allowed for the notice to reach the beneficiary.)

A/B MACs (B) refer questions on payment procedures to the Sanctions Coordinator in the RO.

A/B MACs (B) process laboratory claims inadvertently submitted as unassigned as if they were assigned.

(See §50.)

For purposes of this section, the term assignment includes assignment in the strict sense of the term as well as

the procedure under which payment is made, after the death of the beneficiary, to the person or entity that

furnished the service, on the basis of that person’s or entity’s agreement to accept the Medicare payment as the

full charge or fee for the service.