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Medicare Assignment: Everything You Need to Know

Medicare assignment.

Providers Accepting Assignment
Providers Who Do Not
Billing Options
Assignment of Benefits
How to Choose

Frequently Asked Questions

Medicare assignment is an agreement between Medicare and medical providers (doctors, hospitals, medical equipment suppliers, etc.) in which the provider agrees to accept Medicare’s fee schedule as payment in full when Medicare patients are treated.

This article will explain how Medicare assignment works, and what you need to know in order to ensure that you won’t receive unexpected bills.

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There are 35 million Americans who have Original Medicare. Medicare is a federal program and most medical providers throughout the country accept assignment with Medicare. As a result, these enrollees have a lot more options for medical providers than most of the rest of the population.

They can see any provider who accepts assignment, anywhere in the country. They can be assured that they will only have to pay their expected Medicare cost-sharing (deductible and coinsurance, some or all of which may be paid by a Medigap plan , Medicaid, or supplemental coverage provided by an employer or former employer).

It’s important to note here that the rules are different for the 29 million Americans who have Medicare Advantage plans. These beneficiaries cannot simply use any medical provider who accepts Medicare assignment.

Instead, each Medicare Advantage plan has its own network of providers —much like the health insurance plans that many Americans are accustomed to obtaining from employers or purchasing in the exchange/marketplace .

A provider who accepts assignment with Medicare may or may not be in-network with some or all of the Medicare Advantage plans that offer coverage in a given area. Some Medicare Advantage plans— health maintenance organizations (HMOs) , in particular—will only cover an enrollee’s claims if they use providers who are in the plan's network.

Other Medicare Advantage plans— preferred provider organizations (PPOs) , in particular—will cover out-of-network care but the enrollee will pay more than they would have paid had they seen an in-network provider.

Original Medicare

The bottom line is that Medicare assignment only determines provider accessibility and costs for people who have Original Medicare. People with Medicare Advantage need to understand their own plan’s provider network and coverage rules.

When discussing Medicare assignment and access to providers in this article, keep in mind that it is referring to people who have Original Medicare.

How to Make Sure Your Provider Accepts Assignment

Most doctors, hospitals, and other medical providers in the United States do accept Medicare assignment.

Provider Participation Stats

According to the Centers for Medicare and Medicaid Services, 98% of providers participate in Medicare, which means they accept assignment.

You can ask the provider directly about their participation with Medicare. But Medicare also has a tool that you can use to find participating doctors, hospitals, home health care services, and other providers.

There’s a filter on that tool labeled “Medicare-approved payment.” If you turn on that filter, you will only see providers who accept Medicare assignment. Under each provider’s information, it will say “Charges the Medicare-approved amount (so you pay less out-of-pocket).”

What If Your Provider Doesn’t Accept Assignment?

If your medical provider or equipment supplier doesn’t accept assignment, it means they haven’t agreed to accept Medicare’s approved amounts as payment in full for all of the services.

These providers can still choose to accept assignment on a case-by-case basis. But because they haven’t agreed to accept Medicare assignment for all services, they are considered nonparticipating providers.

Note that "nonparticipating" does not mean that a provider has opted out of Medicare altogether. Medicare will still pay claims for services received from a nonparticipating provider (i.e., one who does not accept Medicare assignment), whereas Medicare does not cover any of the cost of services obtained from a provider who has officially opted out of Medicare.

If a Medicare beneficiary uses a provider who has opted out of Medicare, that person will pay the provider directly and Medicare will not be involved in any way.

Physicians Who Have Opted Out

Only about 1% of all non-pediatric physicians have opted out of Medicare.

For providers who have not opted out of Medicare but who also don’t accept assignment, Medicare will still pay nearly as much as it would have paid if you had used a provider who accepts assignment. Here’s how it works:

Medicare will pay the provider 95% of the amount they would pay if the provider accepted assignment.
The provider can charge the person receiving care more than the Medicare-approved amount, but only up to 15% more (some states limit this further). This extra amount, which the patient has to pay out-of-pocket, is known as the limiting charge . But the 15% cap does not apply to medical equipment suppliers; if they do not accept assignment with Medicare, there is no limit on how much they can charge the person receiving care. This is why it’s particularly important to make sure that the supplier accepts Medicare assignment if you need medical equipment.
The nonparticipating provider may require the person receiving care to pay the entire bill up front and seek reimbursement from Medicare (using Form CMS 1490-S ). Alternatively, they may submit a claim to Medicare on behalf of the person receiving care (using Form CMS-1500 ).
A nonparticipating provider can choose to accept assignment on a case-by-case basis. They can indicate this on Form CMS-1500 in box 27. The vast majority of nonparticipating providers who bill Medicare choose to accept assignment for the claim being billed.
Nonparticipating providers do not have to bill your Medigap plan on your behalf.

Billing Options for Providers Who Accept Medicare

When a medical provider accepts assignment with Medicare, part of the agreement is that they will submit bills to Medicare on behalf of the person receiving care. So if you only see providers who accept assignment, you will never need to submit your own bills to Medicare for reimbursement.

If you have a Medigap plan that supplements your Original Medicare coverage, you should present the Medigap coverage information to the provider at the time of service. Medicare will forward the claim information to your Medigap insurer, reducing administrative work on your part.

Depending on the Medigap plan you have, the services that you receive, and the amount you’ve already spent in out-of-pocket costs, the Medigap plan may pay some or all of the out-of-pocket costs that you would otherwise have after Medicare pays its share.

(Note that if you have a type of Medigap plan called Medicare SELECT, you will have to stay within the plan’s network of providers in order to receive benefits. But this is not the case with other Medigap plans.)

After the claim is processed, you’ll be able to see details in your MyMedicare.gov account . Medicare will also send you a Medicare Summary Notice. This is Medicare’s version of an explanation of benefits (EOB) , which is sent out every three months.

If you have a Medigap plan, it should also send you an EOB or something similar, explaining the claim and whether the policy paid any part of it.

What Is Medicare Assignment of Benefits?

For Medicare beneficiaries, assignment of benefits means that the person receiving care agrees to allow a nonparticipating provider to bill Medicare directly (as opposed to having the person receiving care pay the bill up front and seek reimbursement from Medicare). Assignment of benefits is authorized by the person receiving care in Box 13 of Form CMS-1500 .

If the person receiving care refuses to assign benefits, Medicare can only reimburse the person receiving care instead of paying the nonparticipating provider directly.

Things to Consider Before Choosing a Provider

If you’re enrolled in Original Medicare, you have a wide range of options in terms of the providers you can use—far more than most other Americans. In most cases, your preferred doctor and other medical providers will accept assignment with Medicare, keeping your out-of-pocket costs lower than they would otherwise be, and reducing administrative hassle.

There may be circumstances, however, when the best option is a nonparticipating provider or even a provider who has opted out of Medicare altogether. If you choose one of these options, be sure you discuss the details with the provider before proceeding with the treatment.

You’ll want to understand how much is going to be billed and whether the provider will bill Medicare on your behalf if you agree to assign benefits (note that this is not possible if the provider has opted out of Medicare).

If you have supplemental coverage, you’ll also want to check with that plan to see whether it will still pick up some of the cost and, if so, how much you should expect to pay out of your own pocket.

A medical provider who accepts Medicare assignment is considered a participating provider. These providers have agreed to accept Medicare’s fee schedule as payment in full for services they provide to Medicare beneficiaries. Most doctors, hospitals, and other medical providers do accept Medicare assignment.

Nonparticipating providers are those who have not signed an agreement with Medicare to accept Medicare’s rates as payment in full. However, they can agree to accept assignment on a case-by-case basis, as long as they haven’t opted out of Medicare altogether. If they do not accept assignment, they can bill the patient up to 15% more than the Medicare-approved rate.

Providers who opt out of Medicare cannot bill Medicare and Medicare will not pay them or reimburse beneficiaries for their services. But there is no limit on how much they can bill for their services.

A Word From Verywell

It’s in your best interest to choose a provider who accepts Medicare assignment. This will keep your costs as low as possible, streamline the billing and claims process, and ensure that your Medigap plan picks up its share of the costs.

If you feel like you need help navigating the provider options or seeking care from a provider who doesn’t accept assignment, the Medicare State Health Insurance Assistance Program (SHIP) in your state may be able to help.

A doctor who does not accept Medicare assignment has not agreed to accept Medicare’s fee schedule as payment in full for their services. These doctors are considered nonparticipating with Medicare and can bill Medicare beneficiaries up to 15% more than the Medicare-approved amount.

They also have the option to accept assignment (i.e., accept Medicare’s rate as payment in full) on a case-by-case basis.

There are certain circumstances in which a provider is required by law to accept assignment. This includes situations in which the person receiving care has both Medicare and Medicaid. And it also applies to certain medical services, including lab tests, ambulance services, and drugs that are covered under Medicare Part B (as opposed to Part D).

In 2021, 98% of American physicians had participation agreements with Medicare, leaving only about 2% who did not accept assignment (either as a nonparticipating provider, or a provider who had opted out of Medicare altogether).

Accepting assignment is something that the medical provider does, whereas assignment of benefits is something that the patient (the Medicare beneficiary) does. To accept assignment means that the medical provider has agreed to accept Medicare’s approved fee as payment in full for services they provide.

Assignment of benefits means that the person receiving care agrees to allow a medical provider to bill Medicare directly, as opposed to having the person receiving care pay the provider and then seek reimbursement from Medicare.

Centers for Medicare and Medicaid Services. Medicare monthly enrollment .

Centers for Medicare and Medicaid Services. Annual Medicare participation announcement .

Centers for Medicare and Medicaid Services. Lower costs with assignment .

Centers for Medicare and Medicaid Services. Find providers who have opted out of Medicare .

Kaiser Family Foundation. How many physicians have opted-out of the Medicare program ?

Center for Medicare Advocacy. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) updates .

Centers for Medicare and Medicaid Services. Check the status of a claim .

Centers for Medicare and Medicaid Services. Medicare claims processing manual. Chapter 26 - completing and processing form CMS-1500 data set .

Centers for Medicare and Medicaid Services. Ambulance fee schedule .

Centers for Medicare and Medicaid Services. Prescription drugs (outpatient) .

By Louise Norris Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology.

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What is Medicare assignment and how does it work?

Kimberly Lankford,

Because Medicare decides how much to pay providers for covered services, if the provider agrees to the Medicare-approved amount, even if it is less than they usually charge, they’re accepting assignment.

A doctor who accepts assignment agrees to charge you no more than the amount Medicare has approved for that service. By comparison, a doctor who participates in Medicare but doesn’t accept assignment can potentially charge you up to 15 percent more than the Medicare-approved amount.

That’s why it’s important to ask if a provider accepts assignment before you receive care, even if they accept Medicare patients. If a doctor doesn’t accept assignment, you will pay more for that physician’s services compared with one who does.

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How much do I pay if my doctor accepts assignment?

If your doctor accepts assignment, you will usually pay 20 percent of the Medicare-approved amount for the service, called coinsurance, after you’ve paid the annual deductible. Because Medicare Part B covers doctor and outpatient services, your $240 deductible for Part B in 2024 applies before most coverage begins.

All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies , without paying a deductible or coinsurance if the provider accepts assignment.

What if my doctor doesn’t accept assignment?

A doctor who takes Medicare but doesn’t accept assignment can still treat Medicare patients but won’t always accept the Medicare-approved amount as payment in full.

This means they can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive, called “balance billing.” In this case, you’re responsible for the additional charge, plus the regular 20 percent coinsurance, as your share of the cost.

How to cover the extra cost? If you have a Medicare supplement policy , better known as Medigap, it may cover the extra 15 percent, called Medicare Part B excess charges.

All Medigap policies cover Part B’s 20 percent coinsurance in full or in part. The F and G policies cover the 15 percent excess charges from doctors who don’t accept assignment, but Plan F is no longer available to new enrollees, only those eligible for Medicare before Jan. 1, 2020, even if they haven’t enrolled in Medicare yet. However, anyone who is enrolled in original Medicare can apply for Plan G.

Remember that Medigap policies only cover excess charges for doctors who accept Medicare but don’t accept assignment, and they won’t cover costs for doctors who opt out of Medicare entirely.

Good to know. A few states limit the amount of excess fees a doctor can charge Medicare patients. For example, Massachusetts and Ohio prohibit balance billing, requiring doctors who accept Medicare to take the Medicare-approved amount. New York limits excess charges to 5 percent over the Medicare-approved amount for most services, rather than 15 percent.

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How do I find doctors who accept assignment?

Before you start working with a new doctor, ask whether he or she accepts assignment. About 98 percent of providers billing Medicare are participating providers, which means they accept assignment on all Medicare claims, according to KFF.

You can get help finding doctors and other providers in your area who accept assignment by zip code using Medicare’s Physician Compare tool .

Those who accept assignment have this note under the name: “Charges the Medicare-approved amount (so you pay less out of pocket).” However, not all doctors who accept assignment are accepting new Medicare patients.

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What does it mean if a doctor opts out of Medicare?

Doctors who opt out of Medicare can’t bill Medicare for services you receive. They also aren’t bound by Medicare’s limitations on charges.

In this case, you enter into a private contract with the provider and agree to pay the full bill. Be aware that neither Medicare nor your Medigap plan will reimburse you for these charges.

In 2023, only 1 percent of physicians who aren’t pediatricians opted out of the Medicare program, according to KFF. The percentage is larger for some specialties — 7.7 percent of psychiatrists and 4.2 percent of plastic and reconstructive surgeons have opted out of Medicare.

Keep in mind

These rules apply to original Medicare. Other factors determine costs if you choose to get coverage through a private Medicare Advantage plan . Most Medicare Advantage plans have provider networks, and they may charge more or not cover services from out-of-network providers.

Before choosing a Medicare Advantage plan, find out whether your chosen doctor or provider is covered and identify how much you’ll pay. You can use the Medicare Plan Finder to compare the Medicare Advantage plans and their out-of-pocket costs in your area.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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5 U.S. Code § 7106 - Management rights

Section effective 90 days after Oct. 13, 1978 , see section 907 of Pub. L. 95–454 , set out as an Effective Date of 1978 Amendment note under section 1101 of this title .

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6.4: Assignment, Delegation, and Commonly Used Contracts Clauses

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Learning Objectives

Learn about assignment and delegation.
Examine novation.
Explore restrictions on assignment, exculpatory clauses, noncompete clauses, mandatory arbitration clauses, acceleration clauses, and liquidated damages clauses.
Explore the parol evidence rule.

What if you formed a contract with a rock ’n’ roll band for its services? Specifically, you wanted the band to play at your nightclub, because you thought that your customers would enjoy the band enough to pay to see it perform. You hired this specific band because you heard that it drew large crowds of paying customers. Imagine your surprise when, as you anticipate the band’s performance, you discover that another band—one you have never heard of—has come to play instead of the original contracting band. On inquiry, you learn that the original band transferred its duties to perform to a lesser-known band. Can it do that?

Contract elements—the terms of the contract—are important. They may, among other things, foreclose your ability to bring a complaint in court, they may render you unable to be hired in your profession (at least within certain boundaries), or they may limit liability to a party that had a role in causing injury to you. If you are not aware of these elements, then you may face an unpleasant surprise if you act in a way contrary to the restrictions imposed by those terms. Likewise, contracts possess certain qualities that prohibit parties from acting in certain ways, unless those qualities are expressly waived. This section identifies common properties of contracts, as well as commonly used elements of contracts. If you are negotiating a contract and you do not like a term, then you should not agree to it. In law, there is a presumption that you have read, understood, and agreed to each and every term of any contract to which you are a party. Arguing that you did not understand or that you did not approve of a particular term in the contract will not be a valid excuse to performance. You should know what you can expect when you enter into a contract. Are you getting the band that you wanted to hire to play in your nightclub, or are you really getting any band that the original band happens to transfer its duties to?

As a preliminary matter, it is important to realize that contracts are, by law, assignable and delegable. This means that the rights conveyed by the contract may be transferred to another party by assignment, unless an express restriction on assignment exists within the contract, or unless an assignment would violate public policy. Likewise, the duties imposed on a party may be transferred to another party by delegation, unless the contract expressly restricts delegation, or there is a substantial interest in personal performance by the original party to the contract, or if delegation would violate public policy. In the case of a band hired to perform at a nightclub, an argument could be made that the original band cannot delegate its duties under the contract because there was a substantial interest in personal performance by the original band. This would render the contract nondelegable. To be on the safe side, your contract with that band should have had a clause expressly prohibiting delegation.

Many students have seen restrictions on assignment in the form of no-sublease clauses in leases with landlords. Do you have a no-sublease clause in your lease? If so, that is a restriction on assignment. This clause is necessary to prevent you from assigning your rights under the lease—your rights to inhabit the premises—to another party. It is necessary for the landlord to include that provision expressly if she wishes to prevent you from subleasing the unit, because there is a presumption in law that assignment is permitted unless it is expressly prohibited by the contract or unless the assignment would violate public policy. Since it is unlikely that letting someone else live in your housing unit in your absence would violate public policy, then the landlord must expressly prohibit the assignment within the original contract if she wishes to prevent tenants from subleasing. A landlord may have a very good reason to wish to prevent subleasing; she may wish to ensure that each tenant is creditworthy prior to allowing the tenant to live in the property.

Note that in delegation and in assignment, the original contracting party is not “off the hook” if it transfers its duties or rights to another party. For instance, if subleasing was not prohibited, and the new tenant assumed the rights and duties imposed by the original contract, the original party to the contract is still liable for the payment of rent. If the subleasing tenant does not pay the rent, the original party to the lease is still liable. The way to excuse oneself from this liability is to form a three-way novation with the original party and the new party, thereby excusing the exiting party from future liability arising under the contract. A novation is essentially a new contract that transfers all rights and duties to the new party to the contract and releases the previous party from any further obligation arising from the original contract.

Restrictions on assignment or delegation are not the only common elements that can be found in contracts. For example, you have probably encountered exculpatory clauses. An exculpatory clause is an express limitation on potential or actual liability arising under the subject matter of the contract. In short, exculpatory clauses are often employed when risk of injury exists. They seek to limit one party’s liability to another. You most certainly have signed exculpatory agreements or contracts containing exculpatory clauses if you have participated in any potentially dangerous activity at a club or with an organized group that could incur liability from injuries suffered by its patrons or members. For example, if you join a kayaking club, you will most likely be asked to sign such an agreement to “hold harmless” the club in the event of any accident or injury. However, despite the existence of an exculpatory clause, liability will not be limited (that is, the liability limitations will be unenforceable) when the party who would benefit from the limitation on liability acted with gross negligence, committed an intentional tort, or possessed greatly unequal bargaining power, or if the limitation on liability violates public policy. Imagine that you signed an agreement to engage in kayaking activities with a kayaking group, but the leader of the group battered you with her oar because she was angry with you for mishandling your kayak. Since battery is an intentional tort, the exculpatory clause will not protect the kayaking organization from liability it incurred through the actions of its employee.

Another common contract element that you may have encountered is a noncompete clause. A noncompete clause attempts to restrict competition for a specified period of time, within a certain geographic region, and for specified activities. Noncomplete clauses are generally valid against the party who signed it if the time, place, and scope are reasonable. These are very common clauses in employment contracts, particularly where the duties involved in employment are likely to involve trade secrets or other proprietary information that the company wishes to protect.

A mandatory arbitration clause is very common in consumer contracts and employment contracts. You have certainly subjected yourself to the restrictions imposed by these clauses if you have signed a contract for a credit card. Mandatory arbitration clauses require parties to a contract that contains such a clause to submit to mandatory arbitration in the event of a dispute arising under the contract. Mandatory arbitration clauses frequently foreclose any possibility of appealing arbitration awards in court.

An acceleration clause commonly exists in contracts where periodic payments are contemplated by the agreement. For example, if you signed a lease for your housing unit, then you most likely pay rent on a month-to-month basis. If you breached your lease, you would still owe rent for each subsequent month contemplated by the lease agreement. This means that your landlord would have new injury every month that you did not pay. An acceleration clause accelerates all payments due under the contract on breach. This allows the injured party—in this case, the landlord—to sue for all damages due for unpaid rent under that contract at once, rather than having to bring a new suit each month to seek monthly unpaid rent.

A liquidated damages clause allows parties to set the amount of damages in the event of breach. Agreeing to a damage amount before any breach occurs can save money and time spent litigating. Providing that the liquidated damages clause does not look like a penalty, the clause will be valid and enforced by a court that hears a dispute arising under the contract. For example, imagine that you entered into a contract for the sale of your car. If the liquidated damages clause provided for two thousand dollars of damages in the event of breach, that will probably be a valid liquidated damages clause, providing that your car is an “average” car. However, if the liquidated damages clause provided for one million dollars of damages payable by the breaching party, then that would not be enforceable by the court because it looks like a penalty. The proposed liquidated damages far exceed the value of the car that is the subject of the agreement.

Of course, there are additional common elements to contracts. This is not an exhaustive study of possible provisions, though it is a list of commonly encountered elements. For example, time of performance is often included as a separate provision. However, time for performance is an essential element in common-law contract formation, and without it, the contract may fail due to lack of definite and certain terms in formation.

A major assumption made about a written contract is that it is integrated, which means that it contains the entire expression of the parties’ agreement. That means that any statements made before the parties signed the contract are not part of the contract, unless those statements are memorialized in the contract itself. In fact, any statements or actions that are not captured within the four corners of the contract are considered parol evidence, and they will not be used to interpret the meaning of the contract.

Key Takeaways

Parties to contracts must not only take care to form the agreement so that it is legally enforceable, but they must also be aware of the properties of contracts in general, as well as specific provisions contained within contracts to which they are a party. Properties of contracts include ability to assign, delegate, and exclude parol evidence. Several types of contracts clauses are commonly used to restrict rights and limit liability.

Exercise $\PageIndex{1}$

Think of an example of an exculpatory clause that you have signed. For what type of activity would you be unwilling to sign an exculpatory clause? If your refusal to sign the exculpatory clause or agreement prevented you from participating in that activity, would you still refuse to sign it?
Do you think that too many limitations and restrictions can be placed on parties in a contract? Should there be more government regulation and standardization of contract terms between private parties? Why or why not?

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Mandatory reporting laws.

Richard Thomas ; Monique Reeves .

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Last Update: July 10, 2023 .

Definition/Introduction

In the United States, mandatory reporting laws establish a legally enforceable duty for those who have contact with vulnerable populations to report to state and local authorities when mistreatment or abuse of those populations is suspected or confirmed. While these laws, and the populations they cover, vary by state, they generally include children, the disabled, and the elderly. Some states also assign this reportable duty to abuse between intimate partners. These laws typically cover neglect, as well as physical, sexual, emotional, and financial abuse. While those individuals mandated to report also vary by state, they generally include childcare providers, clergy, coaches, counselors, healthcare providers, law enforcement, principals, and teachers. [1] [2] In addition to their obligation to report mistreatment of vulnerable patients, healthcare professionals are also required to report certain infectious diseases deemed to be public health hazards to state and local authorities. [3]

Issues of Concern

Abuse in the pediatric population is a significant cause of morbidity and mortality. The mistreatment of children is a serious issue of public health concern, and it affects 1 in 8 children before the age of 18 years. Sadly, studies indicate that homicide is within the top five causes of death for children of every age group. [4] The effects of abuse and neglect do not stop at age 18; however, physical and mental health problems due to abuse as a child can extend far into adulthood. [5] Numerous studies have shown a correlation between adults who experienced abuse as children and the development of a host of adult morbidities, ranging from cardiovascular disease to depression. [6]

Intimate Partners

Intimate partner abuse represents an area of abuse sometimes overlooked when compared to other populations. This abuse, however, is experienced by nearly 1 in 3 women during their lifetime. [7] While women are the chief victims of intimate partner abuse, the issue also affects men, with one study showing men comprising 17% of the victims of intimate partner violence. [8] These populations tend to be seen more frequently outside regular business hours when compared to other abused patients. Like other groups, however, victims are often at significant risk for further, more severe injury if there is no intervention. [9]

Abuse and mistreatment are also common among the elderly, with a New England Journal of Medicine study asserting a likely prevalence of 10% of the entire population aged 60 years and above. [10] Elder abuse is made more likely by circumstances facing many elderly patients: poor physical health, functional impairment, and residence in nursing homes. Indeed, those elderly patients residing in nursing homes are at risk of abuse not only from staff but also from other residents. [10] Though frequent, elderly abuse is historically underreported, which has led to the creation of diagnostic tools to aid in its identification. [11] [12]

Infectious Diseases

Policymakers are also concerned with the incidence of certain infectious diseases deemed serious public health concerns. As with laws regarding the mandatory reporting of abuse and mistreatment of vulnerable populations, the number and types of mandatory reportable diseases are dependent on the laws of the governing state, though many states adopt the recommended list published by the Centers for Disease Control (CDC). [3] The CDC regularly publishes updated lists of diseases it recommends for reporting, as this allows the organization to deal with new and novel illnesses as they appear. [13]

Clinical Significance

Healthcare providers have an important ethical and legal role in identifying and reporting abuse in children and other vulnerable populations to their appropriate state agencies. These are issues profoundly affecting the health and well being of a significant portion of the population. In the clinical setting, the most common form of maltreatment reported by healthcare professionals is neglect, which can encompass medical, nutritional, physical, or emotional neglect. [14] These situations are not merely theoretical; for instance, with an estimated 37% of all American children involved with Child Protective Services by the age of 18, many healthcare professionals will deal with these issues frequently in their practice. [15]

In the assessment of suspected abuse, the healthcare provider should obtain a complete history, perform a full physical examination, obtain appropriate laboratory analyses, and contact the proper authorities. [16] [5] Given the fact that each state has different laws, familiarity with the mandatory reporting laws of one’s state is critically important for any healthcare provider. [2] Failure to follow the reporting laws of the state may result in criminal sanctions for the provider, and may even impart civil negligence liability in some jurisdictions. In contrast, providers are not generally liable for reporting suspicious situations subsequently found to be benign. [17]

Regarding the reporting of infectious diseases, the obligation to report certain diseases may be viewed as an obligation of the healthcare provider to the broader community imposed by public policy. Unfortunately, there is significant evidence that many diseases go underreported. Underreporting is likely multifactorial, but may generally be attributable to lack of sufficient knowledge of reportable diseases and confusion with the reporting process in general. [18] Here again, a healthcare provider must know their relevant state laws.

Nursing, Allied Health, and Interprofessional Team Interventions

Training on recognizing and reporting suspected child abuse and neglect is critical to health professional education and patient safety. [19] Such training should apply to all types of healthcare professionals, as each owes a legal duty to report these cases. Systemically, the chances of missing cases of abuse and neglect are minimized if all types of healthcare professionals have similar training regarding recognition of the issue.

The health care team should coordinate with other professionals and community agencies in providing proper treatment and resources to the victimized patient. [5] Similarly, an interprofessional approach is important for the identification of reportable diseases to lessen the risk of underreporting. Reporting these diseases is critical to public health efforts to stem their growth, and ultimately, to allow for their eradication. Such ambitious goals require the participation and coordination of knowledgeable professionals dedicated to their patients and their communities.

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Disclosure: Richard Thomas declares no relevant financial relationships with ineligible companies.

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Synonyms of mandatory

as in compulsory
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Thesaurus Definition of mandatory

Synonyms & Similar Words

involuntary
nonelective
indispensable
all - important

Antonyms & Near Antonyms

discretionary
unnecessary
unimportant
insignificant
inconsequential
dispensable
nonessential

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“Mandatory.” Merriam-Webster.com Thesaurus , Merriam-Webster, https://www.merriam-webster.com/thesaurus/mandatory. Accessed 1 Apr. 2024.

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Why School Absences Have ‘Exploded’ Almost Everywhere

The pandemic changed families’ lives and the culture of education: “Our relationship with school became optional.”

By Sarah Mervosh and Francesca Paris

Sarah Mervosh reports on K-12 education, and Francesca Paris is a data reporter.

In Anchorage, affluent families set off on ski trips and other lengthy vacations, with the assumption that their children can keep up with schoolwork online.

In a working-class pocket of Michigan, school administrators have tried almost everything, including pajama day, to boost student attendance.

And across the country, students with heightened anxiety are opting to stay home rather than face the classroom.

In the four years since the pandemic closed schools, U.S. education has struggled to recover on a number of fronts, from learning loss , to enrollment , to student behavior .

But perhaps no issue has been as stubborn and pervasive as a sharp increase in student absenteeism, a problem that cuts across demographics and has continued long after schools reopened.

Nationally, an estimated 26 percent of public school students were considered chronically absent last school year, up from 15 percent before the pandemic, according to the most recent data, from 40 states and Washington, D.C., compiled by the conservative-leaning American Enterprise Institute . Chronic absence is typically defined as missing at least 10 percent of the school year, or about 18 days, for any reason.

Source: Upshot analysis of data from Nat Malkus, American Enterprise Institute. Districts are grouped into highest, middle and lowest third.

The increases have occurred in districts big and small, and across income and race. For districts in wealthier areas, chronic absenteeism rates have about doubled, to 19 percent in the 2022-23 school year from 10 percent before the pandemic, a New York Times analysis of the data found.

Poor communities, which started with elevated rates of student absenteeism, are facing an even bigger crisis: Around 32 percent of students in the poorest districts were chronically absent in the 2022-23 school year, up from 19 percent before the pandemic.

Even districts that reopened quickly during the pandemic, in fall 2020, have seen vast increases.

“The problem got worse for everybody in the same proportional way,” said Nat Malkus, a senior fellow at the American Enterprise Institute, who collected and studied the data.

Victoria, Texas reopened schools in August 2020, earlier than many other districts. Even so, student absenteeism in the district has doubled.

Kaylee Greenlee for The New York Times

The trends suggest that something fundamental has shifted in American childhood and the culture of school, in ways that may be long lasting. What was once a deeply ingrained habit — wake up, catch the bus, report to class — is now something far more tenuous.

“Our relationship with school became optional,” said Katie Rosanbalm, a psychologist and associate research professor with the Center for Child and Family Policy at Duke University.

The habit of daily attendance — and many families’ trust — was severed when schools shuttered in spring 2020. Even after schools reopened, things hardly snapped back to normal. Districts offered remote options, required Covid-19 quarantines and relaxed policies around attendance and grading .

Source: Nat Malkus, American Enterprise Institute . Includes districts with at least 1,500 students in 2019. Numbers are rounded. U.S. average is estimated.

Today, student absenteeism is a leading factor hindering the nation’s recovery from pandemic learning losses , educational experts say. Students can’t learn if they aren’t in school. And a rotating cast of absent classmates can negatively affect the achievement of even students who do show up, because teachers must slow down and adjust their approach to keep everyone on track.

“If we don’t address the absenteeism, then all is naught,” said Adam Clark, the superintendent of Mt. Diablo Unified, a socioeconomically and racially diverse district of 29,000 students in Northern California, where he said absenteeism has “exploded” to about 25 percent of students. That’s up from 12 percent before the pandemic.

U.S. students, overall, are not caught up from their pandemic losses. Absenteeism is one key reason.

Why Students Are Missing School

Schools everywhere are scrambling to improve attendance, but the new calculus among families is complex and multifaceted.

At South Anchorage High School in Anchorage, where students are largely white and middle-to-upper income, some families now go on ski trips during the school year, or take advantage of off-peak travel deals to vacation for two weeks in Hawaii, said Sara Miller, a counselor at the school.

For a smaller number of students at the school who qualify for free or reduced-price lunch, the reasons are different, and more intractable. They often have to stay home to care for younger siblings, Ms. Miller said. On days they miss the bus, their parents are busy working or do not have a car to take them to school.

And because teachers are still expected to post class work online, often nothing more than a skeleton version of an assignment, families incorrectly think students are keeping up, Ms. Miller said.

Sara Miller sits at a desk, with trophies on the shelves and a computer in front of her.

Sara Miller, a counselor at South Anchorage High School for 20 years, now sees more absences from students across the socioeconomic spectrum.

Ash Adams for The New York Times

Across the country, students are staying home when sick , not only with Covid-19, but also with more routine colds and viruses.

And more students are struggling with their mental health, one reason for increased absenteeism in Mason, Ohio, an affluent suburb of Cincinnati, said Tracey Carson, a district spokeswoman. Because many parents can work remotely, their children can also stay home.

For Ashley Cooper, 31, of San Marcos, Texas, the pandemic fractured her trust in an education system that she said left her daughter to learn online, with little support, and then expected her to perform on grade level upon her return. Her daughter, who fell behind in math, has struggled with anxiety ever since, she said.

“There have been days where she’s been absolutely in tears — ‘Can’t do it. Mom, I don’t want to go,’” said Ms. Cooper, who has worked with the nonprofit Communities in Schools to improve her children’s school attendance. But she added, “as a mom, I feel like it’s OK to have a mental health day, to say, ‘I hear you and I listen. You are important.’”

Experts say missing school is both a symptom of pandemic-related challenges, and also a cause. Students who are behind academically may not want to attend, but being absent sets them further back. Anxious students may avoid school, but hiding out can fuel their anxiety.

And schools have also seen a rise in discipline problems since the pandemic, an issue intertwined with absenteeism.

Dr. Rosanbalm, the Duke psychologist, said both absenteeism and behavioral outbursts are examples of the human stress response, now playing out en masse in schools: fight (verbal or physical aggression) or flight (absenteeism).

Quintin Shepherd stands for a portrait, dressed in a gray blazer and white shirt. Behind him are large bookcases, filled with photos, awards and books.

“If kids are not here, they are not forming relationships,” said Quintin Shepherd, the superintendent in Victoria, Texas.

Quintin Shepherd, the superintendent in Victoria, Texas, first put his focus on student behavior, which he described as a “fire in the kitchen” after schools reopened in August 2020.

The district, which serves a mostly low-income and Hispanic student body of around 13,000, found success with a one-on-one coaching program that teaches coping strategies to the most disruptive students. In some cases, students went from having 20 classroom outbursts per year to fewer than five, Dr. Shepherd said.

But chronic absenteeism is yet to be conquered. About 30 percent of students are chronically absent this year, roughly double the rate before the pandemic.

Dr. Shepherd, who originally hoped student absenteeism would improve naturally with time, has begun to think that it is, in fact, at the root of many issues.

“If kids are not here, they are not forming relationships,” he said. “If they are not forming relationships, we should expect there will be behavior and discipline issues. If they are not here, they will not be academically learning and they will struggle. If they struggle with their coursework, you can expect violent behaviors.”

Teacher absences have also increased since the pandemic, and student absences mean less certainty about which friends and classmates will be there. That can lead to more absenteeism, said Michael A. Gottfried, a professor at the University of Pennsylvania Graduate School of Education. His research has found that when 10 percent of a student’s classmates are absent on a given day, that student is more likely to be absent the following day.

A large atrium like hallway, with students and teachers milling about.

Absent classmates can have a negative impact on the achievement and attendance of even the students who do show up.

Is This the New Normal?

In many ways, the challenge facing schools is one felt more broadly in American society: Have the cultural shifts from the pandemic become permanent?

In the work force, U.S. employees are still working from home at a rate that has remained largely unchanged since late 2022 . Companies have managed to “put the genie back in the bottle” to some extent by requiring a return to office a few days a week, said Nicholas Bloom, an economist at Stanford University who studies remote work. But hybrid office culture, he said, appears here to stay.

Some wonder whether it is time for schools to be more pragmatic.

Lakisha Young, the chief executive of the Oakland REACH, a parent advocacy group that works with low-income families in California, suggested a rigorous online option that students could use in emergencies, such as when a student misses the bus or has to care for a family member. “The goal should be, how do I ensure this kid is educated?” she said.

Students, looking tired, sit at their desks, back to the camera.

Relationships with adults at school and other classmates are crucial for attendance.

In the corporate world, companies have found some success appealing to a sense of social responsibility, where colleagues rely on each other to show up on the agreed-upon days.

A similar dynamic may be at play in schools, where experts say strong relationships are critical for attendance.

There is a sense of: “If I don’t show up, would people even miss the fact that I’m not there?” said Charlene M. Russell-Tucker, the commissioner of education in Connecticut.

In her state, a home visit program has yielded positive results , in part by working with families to address the specific reasons a student is missing school, but also by establishing a relationship with a caring adult. Other efforts — such as sending text messages or postcards to parents informing them of the number of accumulated absences — can also be effective.

Regina Murff, in a tan blazer, stands by the doorway of her home.

Regina Murff has worked to re-establish the daily habit of school attendance for her sons, who are 6 and 12.

Sylvia Jarrus for The New York Times

In Ypsilanti, Mich., outside of Ann Arbor, a home visit helped Regina Murff, 44, feel less alone when she was struggling to get her children to school each morning.

After working at a nursing home during the pandemic, and later losing her sister to Covid-19, she said, there were days she found it difficult to get out of bed. Ms. Murff was also more willing to keep her children home when they were sick, for fear of accidentally spreading the virus.

But after a visit from her school district, and starting therapy herself, she has settled into a new routine. She helps her sons, 6 and 12, set out their outfits at night and she wakes up at 6 a.m. to ensure they get on the bus. If they are sick, she said, she knows to call the absence into school. “I’ve done a huge turnaround in my life,” she said.

But bringing about meaningful change for large numbers of students remains slow, difficult work .

Nationally, about 26 percent of students were considered chronically absent last school year, up from 15 percent before the pandemic.

The Ypsilanti school district has tried a bit of everything, said the superintendent, Alena Zachery-Ross. In addition to door knocks, officials are looking for ways to make school more appealing for the district’s 3,800 students, including more than 80 percent who qualify for free or reduced-price lunch. They held themed dress-up days — ’70s day, pajama day — and gave away warm clothes after noticing a dip in attendance during winter months.

“We wondered, is it because you don’t have a coat, you don’t have boots?” said Dr. Zachery-Ross.

Still, absenteeism overall remains higher than it was before the pandemic. “We haven’t seen an answer,” she said.

Data provided by Nat Malkus, with the American Enterprise Institute. The data was originally published on the Return to Learn tracker and used for the report “ Long COVID for Public Schools: Chronic Absenteeism Before and After the Pandemic .”

The analysis for each year includes all districts with available data for that year, weighted by district size. Data are sourced from states, where available, and the U.S. Department of Education and NCES Common Core of Data.

For the 2018-19 school year, data was available for all 50 states and the District of Columbia. For 2022-23, it was available for 40 states and D.C., due to delays in state reporting.

Closure length status is based on the most in-person learning option available. Poverty is measured using the Census Bureau’s Small Area Income and Poverty Estimates. School size and minority population estimates are from NCES CCD.

How absenteeism is measured can vary state by state, which means comparisons across state lines may not be reliable.

An earlier version of this article misnamed a research center at Duke University. It is the Center for Child and Family Policy, not the Center of Child and Family Policy.

IMAGES

Assignment-1
LM 3 worksheet
Define on Mandatory Signs In The Countryside
Assignment
ADL 2601 Assingment 01
Exercise 1

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January 3, 2024
Mandatory assignment economics
Mandatory English Assignment Procedure Text
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Assignment 2 Define

COMMENTS

Medicare Assignment: What It Is and How It Works
Here's how it works: Medicare will pay the provider 95% of the amount they would pay if the provider accepted assignment. The provider can charge the person receiving care more than the Medicare-approved amount, but only up to 15% more (some states limit this further). This extra amount, which the patient has to pay out-of-pocket, is known as ...
Mandatory assignment
mandatory assignment: A format for reimbursing healthcare services that requires physicians and other providers to accept Medicare reimbursement as payment in full. Under mandatory assignment, balance billing (i.e., billing for the outstanding balance) is not allowed.
What Is Medicare Assignment and How Does It Affect You?
All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies, without paying a deductible or coinsurance if the provider accepts assignment.
PDF Department of The Air Force
Air Force Instruction (DAFI) 36-2110, Total Force Assignments By order of the Secretary of the Air Force, this Department of the Air Force Guidance Memorandum (DAFGM) immediately implements changes to DAFI 36-2110, Total Force Assignments. Compliance with this guidance memorandum is mandatory. To the extent the
Medicare Assignment
Medicare assignment is a fee schedule agreement between the federal government's Medicare program and a doctor or facility. When Medicare assignment is accepted, it means your doctor agrees to the payment terms of Medicare. Doctors that accept Medicare assignment fall under one of three designations: a participating doctor, a non ...
Assignment and Non-assignment of Benefits
Non-assignment of Benefits. Non-assigned is the method of reimbursement a physician/supplier has when choosing to not accept assignment of benefits. Under this method, a non-participating provider is the only provider that can file a claim as non-assigned. When the provider does not accept assignment, the Medicare payment will be made directly ...
Participating Providers versus Non-Participating Providers
This includes practitioners whose services are subject to mandatory assignment as listed below. The reason why it could still be appropriate for such practitioners to enter into a participation agreement is because the mandatory assignment provisions apply only to the particular practitioner service benefit (e.g., nurse practitioner services).
Medicare Mandatory Assignment: An Unnecessary Risk?
In the case of assigned claims, the beneficiary assigns or transfers his or her right to payment from Medicare to the physician. In return, the physician agrees to accept Medicare's approved ...
Medicare Assignment: What It's About, and Who It Affects
1. Participating providers, or those who accept Medicare assignment. These providers have an agreement with Medicare to accept the Medicare-approved amount as full payment for their services. You don't have to pay anything other than a copay or coinsurance (depending on your plan) at the time of your visit.
5 U.S. Code § 7106
5 U.S. Code § 7106 - Management rights. to take whatever actions may be necessary to carry out the agency mission during emergencies. appropriate arrangements for employees adversely affected by the exercise of any authority under this section by such management officials. (Added Pub. L. 95-454, title VII, § 701, Oct. 13, 1978, 92 Stat. 1198 .)
Mandatory Assignment Definition
Mandatory Assignment — The process the Agency uses to assign enrollees to a Managed Care Plan. Potential Enrollee — Pursuant to 42 CFR 438.10 (a), an eligible Medicaid Recipient who is subject to Mandatory Assignment or may voluntarily elect to enroll in a given Health Plan, but is not yet an Enrollee of a specific Health Plan.
Mandatory Definition & Meaning
mandatory: [adjective] required by a law or rule : obligatory.
6.4: Assignment, Delegation, and Commonly Used Contracts Clauses
As a preliminary matter, it is important to realize that contracts are, by law, assignable and delegable. This means that the rights conveyed by the contract may be transferred to another party by assignment, unless an express restriction on assignment exists within the contract, or unless an assignment would violate public policy. Likewise ...
Solved Define the following terms and describe the effect of
Define the following terms and describe the effect of each on the provision of medical care for the elderly: a. mandatory assignment b. balance billing c. capitation d. free choice of provider. There's just one step to solve this.
Mandatory Assignment Price Definition
Define Mandatory Assignment Price. means, with respect to any Purchaser Group selling an interest in a Series 2006-2 Note pursuant to Section 11.1 (g), as of any date of determination, the sum of the amounts set forth in Section 2.6 (d) (i) through (iv); provided that the portion of the Mandatory Assignment Price allocable to amounts set forth ...
Mandatory Reporting Laws
Definition/Introduction. In the United States, mandatory reporting laws establish a legally enforceable duty for those who have contact with vulnerable populations to report to state and local authorities when mistreatment or abuse of those populations is suspected or confirmed. While these laws, and the populations they cover, vary by state ...
MANDATORY Synonyms: 35 Similar and Opposite Words
Synonyms for MANDATORY: compulsory, required, incumbent, necessary, obligatory, urgent, needed, imperative; Antonyms of MANDATORY: optional, voluntary, elective ...
Solved Define the following terms and describe the effect of
Question: Define the following terms and describe the effect of each on the provision of medical care for the elderly:a) mandatory assignment|b) balance billingc) capitationd) free choice of provider ... Mandatory assignment refers to an agreement by a healthcare provider to accept the amount approve... View the full answer.
Solved: Account Assignment Mandatory for Material
Posting G/L account is not found by system thats why it goes for an "Account Assignment" for posting the amount. Possible reasons are, 1) Check "Accounting" view is maintained for the material with valuation class. 2) Check "Material type" and "Account Category Reference" assignment in tcode "OMSK". Show replies.
Solved: Account assignment mandatory for material (enter ...
Accepted Solutions (1) 12-23-2009. hi, Check in configuration of the material type. SPRO > LG > Material Master > Basic settings > Material types > define attributes. For the plant (Val area) , both qty and value updating indicators should be set on. If value updation is unchecked, system would prompt to enter the account assignment category.
Solved: Define the following terms and describe the effect of each on
A mandatory assignment is found extremely helpful for the older people as it guarantees a determined payment of about 80percent of the fee to the medical practitioners directly. Verified Answer A mandatory assignment is the procedure through which the medical reimbursement is made to the physicians directly and the older people do not have to ...
Why School Absences Have 'Exploded' Almost Everywhere
The pandemic changed families' lives and the culture of education: "Our relationship with school became optional."
Solved Define the following terms and describe the impact
Define the following terms and describe the impact each has on the delivery of medical care for elderly populations. a. mandatory assignment b. balance bulling c. capitation d. free choice provider. There are 2 steps to solve this one.
Account Assignment Mandatory?
GOto the sales view of article master and maintain the account assignment group correctly. bcz in your cofiguration this field is mandatory