health care provider accepts assignment

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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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Medicare Assignment

Home / Medicare 101 / Medicare Costs / Medicare Assignment

Summary: If a provider accepts Medicare assignment, they accept the Medicare-approved amount for a covered service. Though most providers accept assignment, not all do. In this article, we’ll explain the differences between participating, non-participating, and opt-out providers. You’ll also learn how to find physicians in your area who accept Medicare assignment. Estimated Read Time: 5 min

What is Medicare Assignment

Medicare assignment is an agreement by your doctor or other healthcare providers to accept the Medicare-approved amount as the full cost for a covered service. Providers who “accept assignment” bill Medicare directly for Part B-covered services and cannot charge you more than the applicable deductible and coinsurance.

Most healthcare providers who opt-in to Medicare accept assignment. In fact, CMS reported in its Medicare Participation for Calendar Year 2024 announcement that 98 percent of Medicare providers accepted assignment in 2023.

Providers who accept Medicare are divided into two groups: Participating providers and non-participating providers. Providers can decide annually whether they want to participate in Medicare assignment, or if they want to be non-participating.

Providers who do not accept Medicare Assignment can charge up to 15% above the Medicare-approved cost for a service. If this is the case, you will be responsible for the entire amount (up to 15%) above what Medicare covers.

Below, we’ll take a closer look at participating, non-participating, and opt-out physicians.

Medicare Participating Providers: Providers Who Accept Medicare Assignment

Healthcare providers who accept Medicare assignment are known as “participating providers”. To participate in Medicare assignment, a provider must enter an agreement with Medicare called the Participating Physician or Supplier Agreement. When a provider signs this agreement, they agree to accept the Medicare-approved charge as the full charge of the service. They cannot charge the beneficiary more than the applicable deductible and coinsurance for covered services.

Each year, providers can decide whether they want to be a participating or non-participating provider. Participating in Medicare assignment is not only beneficial to patients, but to providers as well. Participating providers get paid by Medicare directly, and when a participating provider bills Medicare, Medicare will automatically forward the claim information to Medicare Supplement insurers. This makes the billing process much easier on the provider’s end.

Medicare Non-Participating Providers: Providers Who Don’t Accept Assignment

Healthcare providers who are “non-participating” providers do not agree to accept assignment and can charge up to 15% over the Medicare-approved amount for a service. Non-participating Medicare providers still accept Medicare patients. However they have not agreed to accept the Medicare-approved cost as the full cost for their service.

Doctors who do not sign an assignment agreement with Medicare can still choose to accept assignment on a case-by-case basis. When non-participating providers do add on excess charges , they cannot charge more than 15% over the Medicare-approved amount. It’s worth noting that providers do not have to charge the maximum 15%; they may only charge 5% or 10% over the Medicare-approved amount.

When you receive a Medicare-covered service at a non-participating provider, you may need to pay the full amount at the time of your service; a claim will need to be submitted to Medicare for you to be reimbursed. Prior to receiving care, your provider should give you an Advanced Beneficiary Notice (ABN) to read and sign. This notice will detail the services you are receiving and their costs.

Non-participating providers should include a CMS-approved unassigned claim statement in the additional information section of your Advanced Beneficiary Notice. This statement will read:

“This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”

This statement basically summarizes how excess charges work: Medicare will pay the Medicare-approved amount, but you may end up paying more than that.

Your provider should submit a claim to Medicare for any covered services, however, if they refuse to submit a claim, you can do so yourself by using CMS form 1490S .

Opt-Out Providers: What You Need to Know

Opt-out providers are different than non-participating providers because they completely opt out of Medicare. What does this mean for you? If you receive supplies or services from a provider who opted out of Medicare, Medicare will not pay for any of it (except for emergencies).

Physicians who opt-out of Medicare are even harder to find than non-participating providers. According to a report by KFF.org, only 1.1% of physicians opted out of Medicare in 2023. Of those who opted out, most are physicians in specialty fields such as psychiatry, plastic and reconstructive surgery, and neurology.

How to Find A Doctor Who Accepts Medicare Assignment

Finding a doctor who accepts Medicare patients and accepts Medicare assignment is generally easier than finding a provider who doesn’t accept assignment. As we mentioned above, of all the providers who accept Medicare patients, 98 percent accept assignment.

The easiest way to find a doctor or healthcare provider who accepts Medicare assignment is by visiting Medicare.gov and using their Compare Care Near You tool . When you search for providers in your area, the Care Compare tool will let you know whether a provider is a participating or non-participating provider.

If a provider is part of a group practice that involves multiple providers, then all providers in that group must have the same participation status. As an example, we have three doctors, Dr. Smith, Dr. Jones, and Dr. Shoemaker, who are all part of a group practice called “Health Care LLC”. The group decides to accept Medicare assignment and become a participating provider. Dr. Smith decides he does not want to accept assignment, however, because he is part of the “Health Care LLC” group, he must remain a participating provider.

Using Medicare’s Care Compare tool, you can select a group practice and see their participation status. You can then view all providers who are part of that group. This makes finding doctors who accept assignment even easier.

To ensure you don’t end up paying more out-of-pocket costs than you anticipated, it’s always a good idea to check with your provider if they are a participating Medicare provider. If you have questions regarding Medicare assignment or are having trouble determining whether a provider is a participating provider, you can contact Medicare directly at 1-800-633-4227. If you have questions about excess charges or other Medicare costs and would like to speak with a licensed insurance agent, you can contact us at the number above.

Announcement About Medicare Participation for Calendar Year 2024, Centers for Medicare & Medicaid Services. Accessed January 2024

https://www.cms.gov/files/document/medicare-participation-announcement.pdf

Annual Medicare Participation Announcement, CMS.gov. Accessed January 2024

https://www.cms.gov/medicare-participation

Does Your Provider Accept Medicare as Full Payment? Medicare.gov. Accessed January 2024

https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare

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If you have Original Medicare , your Part B costs once you have met your deductible can vary depending on the type of provider you see. For cost purposes, there are three types of provider, meaning three different relationships a provider can have with Medicare . A provider’s type determines how much you will pay for Part B -covered services.

• These providers are required to submit a bill (file a claim ) to Medicare for care you receive. Medicare will process the bill and pay your provider directly for your care. If your provider does not file a claim for your care, there are troubleshooting steps to help resolve the problem .
• If you see a participating provider , you are responsible for paying a 20% coinsurance for Medicare-covered services.
• Certain providers, such as clinical social workers and physician assistants, must always take assignment if they accept Medicare.
• Non-participating providers can charge up to 15% more than Medicare’s approved amount for the cost of services you receive (known as the limiting charge ). This means you are responsible for up to 35% (20% coinsurance + 15% limiting charge) of Medicare’s approved amount for covered services.
• Some states may restrict the limiting charge when you see non-participating providers. For example, New York State’s limiting charge is set at 5%, instead of 15%, for most services. For more information, contact your State Health Insurance Assistance Program (SHIP) .
• If you pay the full cost of your care up front, your provider should still submit a bill to Medicare. Afterward, you should receive from Medicare a Medicare Summary Notice (MSN) and reimbursement for 80% of the Medicare-approved amount .
• The limiting charge rules do not apply to durable medical equipment (DME) suppliers . Be sure to learn about the different rules that apply when receiving services from a DME supplier .
• Medicare will not pay for care you receive from an opt-out provider (except in emergencies). You are responsible for the entire cost of your care.
• The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you.
• Opt-out providers do not bill Medicare for services you receive.
• Many psychiatrists opt out of Medicare.

Providers who take assignment should submit a bill to a Medicare Administrative Contractor (MAC) within one calendar year of the date you received care. If your provider misses the filing deadline, they cannot bill Medicare for the care they provided to you. However, they can still charge you a 20% coinsurance and any applicable deductible amount.

Be sure to ask your provider if they are participating, non-participating, or opt-out. You can also check by using Medicare’s Physician Compare tool .

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What Is Medicare Assignment?

Written by: Rachael Zimlich, RN, BSN

Reviewed by: Eboni Onayo, Licensed Insurance Agent

Key Takeaways

Medicare assignment describes the fee structure that your doctor and Medicare have agreed to use.

If your doctor agrees to accept Medicare assignment, they agree to be paid whatever amount Medicare has approved for a service.

You may still see doctors who don’t accept Medicare assignment, but you may have to pay for your visit up front and submit a claim to Medicare for reimbursement.

You may have to pay more to see doctors who don’t accept Medicare assignment.

How Does Medicare Assignment Work?

What is Medicare assignment ?

Medicare assignment simply means that your provider has agreed to stick to a Medicare fee schedule when it comes to what they charge for tests and services. Medicare regularly updates fee schedules, setting specific limits for what it will cover for things like office visits and lab testing.

When a provider agrees to accept Medicare assignment, they cannot charge more than the Medicare-approved amount. For you, this means your out-of-pocket costs may be lower than if you saw a provider who did not accept Medicare assignment. The provider acknowledges that the amount Medicare set for a particular service is the maximum amount that will be paid.

You may still have to pay a Medicare deductible and coinsurance, but your provider will have to submit a claim to Medicare directly and wait for payment before passing any share of the costs onto you. Doctors who accept Medicare assignment cannot charge you to submit these claims.

My Medicare coverage doesn’t address all of my needs.

How Do I Know if a Provider Accepts Medicare Assignment?

There are a few levels of commitment when it comes to Medicare assignment.

• Providers who have agreed to accept Medicare assignment sign a contract with Medicare.
• Those who have not signed a contract with Medicare can still accept assignment amounts for services of their choice. They do not have to accept assignment for every service provided. These are called non-participating providers.
• Some providers opt out of Medicare altogether. Doctors who have opted out of Medicare completely or who use private contracts will not be paid anything by Medicare, even if it’s for a covered service within the fee limits. You will have to pay the full cost of any services provided by these doctors yourself.

You can check to see if your provider accepts Medicare assignment on Medicare’s website .

Billing Arrangement Options for Providers Who Accept Medicare

Doctors that take Medicare can sign a contract to accept assignment for all Medicare services, or be a non-participating provider that accepts assignment for some services but not all.

A medical provider that accepts Medicare assignment must submit claims directly to Medicare on your behalf. They will be paid the agreed upon amount by Medicare, and you will pay any copayments or deductibles dictated by your plan.

If your doctor is non-participating, they may accept Medicare assignment for some services but not others. Even if they do agree to accept Medicare’s fee for some services, Medicare will only pay then 95% of the set assignment cost for a particular service.

If your provider does plan to work with Medicare, either the provider or you can submit a claim to Medicare, but you may have to pay the entire cost of the visit up front and wait for reimbursement. They can’t charge you for more than the amount approved by Medicare, but they can charge you above the Medicare-approved amount. This is called the limiting charge, and can be up to 15% more than Medicare-approved amount for non-participating providers.

What Does It Mean When a Provider Does Not Accept Medicare Assignment?

Providers who refuse Medicare assignment can still choose to accept Medicare’s set fees for certain services. These are called non-participating providers.

There are a number of providers who opt out of participating in Medicare altogether; they are referred to as “opt-out doctors”. This means they have signed an opt-out agreement with Medicare and can’t be paid by Medicare at all — even for services normally covered by Medicare. Opt-out contracts last for at least two years. Some of these providers may only offer services to patients who sign contracts.

You do not need to sign a contract with a private provider or use an opt-out provider. There are many options for alternative providers who accept Medicare. If you do choose an opt-out or private contract provider, you will have to pay the full cost of services on your own.

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Do providers have to accept Medicare assignment?

No. Providers can choose to accept a full Medicare assignment, or accept assignment rates for some services as a non-participating provider. Doctors can also opt out of participating in Medicare altogether.

How much will I have to pay if my provider doesn't accept Medicare assignment?

Some providers that don’t accept assignment as a whole will accept assignment for some services. These are called non-participating providers. For these providers and providers who have completely opted out of Medicare, you will pay the majority of or the full amount for your care.

How do I submit a claim?

If you need to submit your own claim to Medicare, you can call 1-800-MEDICARE or use Form CMS-1490S .

Can my provider charge to submit a claim?

No. Providers are not allowed to charge to submit a claim to Medicare on your behalf.

Lower Costs with Assignment. Medicare.gov.

Fee Schedules . CMS.gov.

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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Medicare Frequently Asked Questions

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As a Medical Biller, the better you understand the medical insurance payment process, the better you can care for your patients. Your understanding of what a patient will owe and what will be covered can help them navigate the confusing world of medical insurance.

One term that can be very confusing for patients (and for doctors as well) is ‘Accepting Assignment’.

Essentially, ‘assignment’ means that a doctor, (also known as provider or supplier) agrees (or is required by law) to accept a Medicare-approved amount as full payment for covered services.

This amount may be lower or higher than an individual’s insurance amount, but will be on par with Medicare fees for the services.

If a doctor participates with an insurance carrier, they have a contract and agree that the provider will accept the allowed amount, then the provider would check “yes”.  

If they do not participate and do not wish to accept what the insurance carrier allows, they would check “no”.   It is important to note that a provider who does not participate can still opt to accept assignment on just a particular claim by checking the “yes” box just for those services.

In other words by saying your office will accept assignment, you are agreeing to the payment amount being covered by the insurer, or medicare, and the patient has no responsibility.

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Balance Billing in Health Insurance

• How It Works
• When It Happens
• What to Do If You Get a Bill
• If You Know in Advance

Balance billing happens after you’ve paid your deductible , coinsurance or copayment and your insurance company has also paid everything it’s obligated to pay toward your medical bill. If there is still a balance owed on that bill and the healthcare provider or hospital expects you to pay that balance, you’re being balance billed.

This article will explain how balance billing works, and the rules designed to protect consumers from some instances of balance billing.

Is Balance Billing Legal or Not?

Sometimes it’s legal, and sometimes it isn’t; it depends on the circumstances.

Balance billing is generally illegal :

• When you have Medicare and you’re using a healthcare provider that accepts Medicare assignment .
• When you have Medicaid and your healthcare provider has an agreement with Medicaid.
• When your healthcare provider or hospital has a contract with your health plan and is billing you more than that contract allows.
• In emergencies (with the exception of ground ambulance charges), or situations in which you go to an in-network hospital but unknowingly receive services from an out-of-network provider.

In the first three cases, the agreement between the healthcare provider and Medicare, Medicaid, or your insurance company includes a clause that prohibits balance billing.

For example, when a hospital signs up with Medicare to see Medicare patients, it must agree to accept the Medicare negotiated rate, including your deductible and/or coinsurance payment, as payment in full. This is called accepting Medicare assignment .

And for the fourth case, the No Surprises Act , which took effect in 2022, protects you from "surprise" balance billing.

Balance billing is usually legal :

• When you choose to use a healthcare provider that doesn’t have a relationship or contract with your insurer (including ground ambulance charges, even after implementation of the No Surprises Act).
• When you’re getting services that aren’t covered by your health insurance policy, even if you’re getting those services from a provider that has a contract with your health plan.

The first case (a provider not having an insurer relationship) is common if you choose to seek care outside of your health insurance plan's network.

Depending on how your plan is structured, it may cover some out-of-network costs on your behalf. But the out-of-network provider is not obligated to accept your insurer's payment as payment in full. They can send you a bill for the remainder of the charges, even if it's more than your plan's out-of-network copay or deductible.

(Some health plans, particularly HMOs and EPOs , simply don't cover non-emergency out-of-network services at all, which means they would not cover even a portion of the bill if you choose to go outside the plan's network.)

Getting services that are not covered is a situation that may arise, for example, if you obtain cosmetic procedures that aren’t considered medically necessary, or fill a prescription for a drug that isn't on your health plan's formulary . You’ll be responsible for the entire bill, and your insurer will not require the medical provider to write off any portion of the bill—the claim would simply be rejected.

Prior to 2022, it was common for people to be balance billed in emergencies or by out-of-network providers that worked at in-network hospitals. In some states, state laws protected people from these types of surprise balance billing if they had state-regulated health plans.

But not all states had these protections. And the majority of people with employer-sponsored health insurance are covered under self-insured plans, which are not subject to state regulations. This is why the No Surprises Act was so necessary.

How Balance Billing Works

When you get care from a doctor, hospital, or other healthcare provider that isn’t part of your insurer’s provider network  (or, if you have Medicare, from a provider that has opted out of Medicare altogether , which is rare but does apply in some cases ), that healthcare provider can charge you whatever they want to charge you (with the exception of emergencies or situations where you receive services from an out-of-network provider while you're at an in-network hospital).

Since your insurance company hasn’t negotiated any rates with that provider, they aren't bound by a contract with your health plan.

Medicare Limiting Charge

If you have Medicare and your healthcare provider is a nonparticipating provider but hasn't entirely opted out of Medicare, you can be charged up to 15% more than the allowable Medicare amount for the service you receive (some states impose a lower limit).

This 15% cap is known as the limiting charge, and it serves as a restriction on balance billing in some cases. If your healthcare provider has opted out of Medicare entirely, they cannot bill Medicare at all and you'll be responsible for the full cost of your visit.

If your health insurance company agrees to pay a percentage of your out-of-network care, the health plan doesn’t pay a percentage of what’s actually billed . Instead, it pays a percentage of what it says should have been billed, otherwise known as a reasonable and customary amount.

As you might guess, the reasonable and customary amount is usually lower than the amount you’re actually billed. The balance bill comes from the gap between what your insurer says is reasonable and customary, and what the healthcare provider or hospital actually charges.

Let's take a look at an example in which a person's health plan has 20% coinsurance for in-network hospitalization and 40% coinsurance for out-of-network hospitalization. And we're going to assume that the No Surprises Act does not apply (ie, that the person chooses to go to an out-of-network hospital, and it's not an emergency situation).

In this scenario, we'll assume that the person already met their $1,000 in-network deductible and $2,000 out-of-network deductible earlier in the year (so the example is only looking at coinsurance).

And we'll also assume that the health plan has a $6,000 maximum out-of-pocket for in-network care, but no cap on out-of-pocket costs for out-of-network care:

When Does Balance Billing Happen?

In the United States, balance billing usually happens when you get care from a healthcare provider or hospital that isn’t part of your health insurance company’s provider network or doesn’t accept Medicare or Medicaid rates as payment in full.

If you have Medicare and your healthcare provider has opted out of Medicare entirely, you're responsible for paying the entire bill yourself. But if your healthcare provider hasn't opted out but just doesn't accept assignment with Medicare (ie, doesn't accept the amount Medicare pays as payment in full), you could be balance billed up to 15% more than Medicare's allowable charge, in addition to your regular deductible and/or coinsurance payment.

Surprise Balance Billing

Receiving care from an out-of-network provider can happen unexpectedly, even when you try to stay in-network. This can happen in emergency situations—when you may simply have no say in where you're treated or no time to get to an in-network facility—or when you're treated by out-of-network providers who work at in-network facilities.

For example, you go to an in-network hospital, but the radiologist who reads your X-rays isn’t in-network. The bill from the hospital reflects the in-network rate and isn't subject to balance billing, but the radiologist doesn’t have a contract with your insurer, so they can charge you whatever they want. And prior to 2022, they were allowed to send you a balance bill unless state law prohibited it.

Similar situations could arise with:

• Anesthesiologists
• Pathologists (laboratory doctors)
• Neonatologists (doctors for newborns)
• Intensivists (doctors who specialize in ICU patients)
• Hospitalists (doctors who specialize in hospitalized patients)
• Radiologists (doctors who interpret X-rays and scans)
• Ambulance services to get you to the hospital, especially air ambulance services, where balance billing was frighteningly common
• Durable medical equipment suppliers (companies that provide the crutches, braces, wheelchairs, etc. that people need after a medical procedure)

These "surprise" balance billing situations were particularly infuriating for patients, who tended to believe that as long as they had selected an in-network medical facility, all of their care would be covered under the in-network terms of their health plan.

To address this situation, many states enacted consumer protection rules that limited surprise balance billing prior to 2022. But as noted above, these state rules don't protect people with self-insured employer-sponsored health plans, which cover the majority of people who have employer-sponsored coverage.

There had long been broad bipartisan support for the idea that patients shouldn't have to pay additional, unexpected charges just because they needed emergency care or inadvertently received care from a provider outside their network, despite the fact that they had purposely chosen an in-network medical facility. There was disagreement, however, in terms of how these situations should be handled—should the insurer have to pay more, or should the out-of-network provider have to accept lower payments? This disagreement derailed numerous attempts at federal legislation to address surprise balance billing.

But the Consolidated Appropriations Act, 2021, which was enacted in December 2020, included broad provisions (known as the No Surprises Act) to protect consumers from surprise balance billing as of 2022. The law applies to both self-insured and fully-insured plans, including grandfathered plans, employer-sponsored plans, and individual market plans.

It protects consumers from surprise balance billing charges in nearly all emergency situations and situations when out-of-network providers offer services at in-network facilities, but there's a notable exception for ground ambulance charges.

This is still a concern, as ground ambulances are among the medical providers most likely to balance bill patients and least likely to be in-network, and patients typically have no say in what ambulance provider comes to their rescue in an emergency situation. But other than ground ambulances, patients are no longer subject to surprise balance bills as of 2022.

The No Surprises Act did call for the creation of a committee to study ground ambulance charges and make recommendations for future legislation to protect consumers. The Biden Administration announced the members of that committee in late 2022, and the committee began holding meetings in May 2023.

Balance billing continues to be allowed in other situations (for example, the patient simply chooses to use an out-of-network provider). Balance billing can also still occur when you’re using an in-network provider, but you’re getting a service that isn’t covered by your health insurance. Since an insurer doesn’t negotiate rates for services it doesn’t cover, you’re not protected by that insurer-negotiated discount. The provider can charge whatever they want, and you’re responsible for the entire bill.

It is important to note that while the No Surprises Act prohibits balance bills from out-of-network working at in-network facilities, the final rule for implementation of the law defines facilities as "hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers." Other medical facilities are not covered by the consumer protections in the No Surprises Act.

Balance billing doesn’t usually happen with in-network providers or providers that accept Medicare assignment . That's because if they balance bill you, they’re violating the terms of their contract with your insurer or Medicare. They could lose the contract, face fines, suffer severe penalties, and even face criminal charges in some cases.

If You Get an Unexpected Balance Bill

Receiving a balance bill is a stressful experience, especially if you weren't expecting it. You've already paid your deductible and coinsurance and then you receive a substantial additional bill—what do you do next?

First, you'll want to try to figure out whether the balance bill is legal or not. If the medical provider is in-network with your insurance company, or you have Medicare or Medicaid and your provider accepts that coverage, it's possible that the balance bill was a mistake (or, in rare cases, outright fraud).

And if your situation is covered under the No Surprises Act (ie, an emergency, or an out-of-network provider who treated you at an in-network facility), you should not be subject to a balance bill. So be sure you understand what charges you're actually responsible for before paying any medical bills.

If you think that the balance bill was an error, contact the medical provider's billing office and ask questions. Keep a record of what they tell you so that you can appeal to your state's insurance department if necessary.

If the medical provider's office clarifies that the balance bill was not an error and that you do indeed owe the money, consider the situation—did you make a mistake and select an out-of-network healthcare provider? Or was the service not covered by your health plan?

If you went to an in-network facility for a non-emergency, did you waive your rights under the No Surprises Act (NSA) and then receive a balance bill from an out-of-network provider? This is still possible in limited circumstances, but you would have had to sign a document indicating that you had waived your NSA protections.

Negotiate With the Medical Office

If you've received a legitimate balance bill, you can ask the medical office to cut you some slack. They may be willing to agree to a payment plan and not send your bill to collections as long as you continue to make payments.

Or they may be willing to reduce your total bill if you agree to pay a certain amount upfront. Be respectful and polite, but explain that the bill caught you off guard. And if it's causing you significant financial hardship, explain that too.

The healthcare provider's office would rather receive at least a portion of the billed amount rather than having to wait while the bill is sent to collections. So the sooner you reach out to them, the better.

Negotiate With Your Insurance Company

You can also negotiate with your insurer. If your insurer has already paid the out-of-network rate on the reasonable and customary charge, you’ll have difficulty filing a formal appeal since the insurer  didn’t actually deny your claim . It paid your claim, but at the out-of-network rate.

Instead, request a reconsideration. You want your insurance company to  reconsider the decision to cover this as out-of-network care , and instead cover it as in-network care. You’ll have more luck with this approach if you had a compelling medical or logistical reason for choosing an out-of-network provider .

If you feel like you’ve been treated unfairly by your insurance company, follow your health plan’s internal complaint resolution process.

You can get information about your insurer’s complaint resolution process in your benefits handbook or from your human resources department. If this doesn’t resolve the problem, you can complain to your state’s insurance department.

• Learn more about your internal and external appeal rights.
• Find contact information for your Department of Insurance using this resource .

If your health plan is self-funded , meaning your employer is the entity actually paying the medical bills even though an insurance company may administer the plan, then your health plan won't fall under the jurisdiction of your state’s department of insurance.

Self-funded plans are instead regulated by the Department of Labor’s Employee Benefit Services Administration. Get more information from the  EBSA’s consumer assistance web page  or by calling an EBSA benefits advisor at 1-866-444-3272.

If You Know You’ll Be Legally Balance Billed

If you know in advance that you’ll be using an out-of-network provider or a provider that doesn’t accept Medicare assignment, you have some options. However, none of them are easy and all require some negotiating.

Ask for an estimate of the provider’s charges. Next, ask your insurer what they consider the reasonable and customary charge for this service to be. Getting an answer to this might be tough, but be persistent.

Once you have estimates of what your provider will charge and what your insurance company will pay, you’ll know how far apart the numbers are and what your financial risk is. With this information, you can narrow the gap. There are only two ways to do this: Get your provider to charge less or get your insurer to pay more.

Ask the provider if he or she will accept your insurance company’s reasonable and customary rate as payment in full. If so, get the agreement in writing, including a no-balance-billing clause.

If your provider won’t accept the reasonable and customary rate as payment in full, start working on your insurer. Ask your insurer to increase the amount they’re calling reasonable and customary for this particular case.

Present a convincing argument by pointing out why your case is more complicated, difficult, or time-consuming to treat than the average case the insurer bases its reasonable and customary charge on.

Single-Case Contract

Another option is to ask your insurer to negotiate a  single-case contract   with your out-of-network provider for this specific service.

A single-case contract is more likely to be approved if the provider is offering specialized services that aren't available from locally-available in-network providers, or if the provider can make a case to the insurer that the services they're providing will end up being less expensive in the long-run for the insurance company.

Sometimes they can agree upon a single-case contract for the amount your insurer usually pays its in-network providers. Sometimes they’ll agree on a single-case contract at the discount rate your healthcare provider accepts from the insurance companies she’s already in-network with.

Or, sometimes they can agree on a single-case contract for a percentage of the provider’s billed charges. Whatever the agreement, make sure it includes a no-balance-billing clause.

Ask for the In-Network Coinsurance Rate

If all of these options fail, you can ask your insurer to cover this out-of-network care using your in-network coinsurance rate. While this won’t prevent balance billing, at least your insurer will be paying a higher percentage of the bill since your coinsurance for in-network care is lower than for out-of-network care.

If you pursue this option, have a convincing argument as to why the insurer should treat this as in-network. For example, there are no local in-network surgeons experienced in your particular surgical procedure, or the complication rates of the in-network surgeons are significantly higher than those of your out-of-network surgeon.

Balance billing refers to the additional bill that an out-of-network medical provider can send to a patient, in addition to the person's normal cost-sharing and the payments (if any) made by their health plan. The No Surprises Act provides broad consumer protections against "surprise" balance billing as of 2022.

A Word From Verywell

Try to prevent balance billing by staying in-network, making sure your insurance company covers  the services you’re getting, and complying with any pre-authorization requirements. But rest assured that the No Surprises Act provides broad protections against surprise balance billing.

This means you won't be subject to balance bills in emergencies (except for ground ambulance charges, which can still generate surprise balance bills) or in situations where you go to an in-network hospital but unknowingly receive care from an out-of-network provider.

Congress.gov. H.R.133—Consolidated Appropriations Act, 2021 . Enacted December 27, 2021.

Kona M. The Commonwealth Fund. State balance billing protections . April 20, 2020.

Data.CMS.gov. Opt Out Affidavits .

Chhabra, Karan; Schulman, Kevin A.; Richman, Barak D. Health Affairs. Are Air Ambulances Truly Flying Out Of Reach? Surprise-Billing Policy And The Airline Deregulation Act . October 17, 2019.

Kaiser Family Foundation. 2022 Employer Health Benefits Survey .

Centers for Medicare and Medicaid Services. Members of New Federal Advisory Committee Named to Help Improve Ground Ambulance Disclosure and Billing Practices for Consumers . December 13, 2022.

Centers for Medicare and Medicaid Services. Advisory Committee on Ground Ambulance and Patient Billing (GAPB) .

Internal Revenue Service; Employee Benefits Security Administration; Health and Human Services Department. Requirements Related to Surprise Billing . August 26, 2022.

National Conference of State Legislatures. States Tackling "Balance Billing" Issue . July 2017.

By Elizabeth Davis, RN Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing.

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Provider Assignment

On this page:, provider nomination and the geographic assignment rule.

• Part A and Part B (A/B) and Home Health and Hospice (HH+H)
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Section 911(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Public Law 108-173 , repealed the provider nomination provisions formerly found in Section 1816 of the Title XVIII of the Social Security Act and replaced it with the Geographic Assignment Rule.  Generally, a provider or supplier will be assigned to the Medicare Administrative Contractor (MAC) that covers the state where the provider or supplier is located. The Center for Medicare & Medicaid Services’ (CMS) has defined the following approach for assigning providers, physicians, and suppliers to MACs.

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Part A/Part B (A/B) and Home Health and Hospice (HH+H) Rule

All A/B and HH+H providers will be assigned to the MAC contracted by CMS to administer A/B and HH+H claims for the geographic locale in which the provider is physically located.  Learn more about the current A/B MAC jurisdictions and HH+H areas and view the corresponding maps at Who are the MACs.

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Rule

Each DMEPOS supplier submits claims to the DME MAC contracted by CMS to administer DMEPOS claims for the geographic locale in which the beneficiary resides permanently.  Learn more about the current DME MAC jurisdictions and view the corresponding map at Who are the MACs.

Specialty Providers and Demonstrations Rule

Specialty providers and providers involved with certain demonstrations will submit claims to a specific MAC designated by CMS.  Learn more about a specific A/B MAC or DME MAC and view the corresponding maps at Who are the MACs .

Railroad Retirement Beneficiaries Entitled to Medicare Rule

Physicians and other suppliers (except for DMEPOS suppliers) will continue to enroll with and bill the contractor designated by the Railroad Retirement Board for Part B services furnished to their beneficiaries.  Each DMEPOS supplier will submit claims to the DME MAC contracted by CMS to administer DMEPOS claims for the geographic locale in which the beneficiary resides permanently.  Learn more about the current DME MAC jurisdictions and view the corresponding map at W ho are the MACs.

Qualified Chains Rule

The Geographic Assignment Rule states that generally, a provider or supplier will be assigned to the MAC that covers the state where the provider or supplier is located.  However, it does provide an exception for qualified chains.  A qualified chain home office may request that its hospitals and skilled nursing facilities be serviced by the A/B MAC that covers the state where the home office is located.  A qualified chain home office may send an inquiry to:   CMS [email protected]

Out-of-Jurisdiction Providers (OJP) Rule

An OJP is a provider that is not currently assigned to an A/B MAC in accordance with the geographic assignment rule and the qualified chain exception.  For example, a hospital not part of a qualified chain located in Maine, but currently assigned to the A/B MAC in Jurisdiction F would be an OJP.

Each A/B MAC will initially service some OJPs until CMS undertakes the final reassignment of all OJPs to their destination MACs based on the geographic assignment rule and its exceptions.

CMS has not set a timetable for moving OJP’s.

• Pennsylvania

Dr. Gary F Salak

• MEDICARE CERTIFIED
• 28+ YEARS EXP
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Dr. Gary F Salak, OD, is an Optometry specialist in Moscow, Pennsylvania. He attended and graduated from Pennsylvania College Of Optometry in 1996, having over 28 years of diverse experience, especially in Optometry. Dr. Gary F Salak may accept Medicare Assignment. Call (570) 843-6054 to request Dr. Gary F Salak the information (Medicare information, advice, payment, ...) or simply to book an appointment.

Doctor Profile

Medical Specialties

• Optometry (primary specialty)
• Over 28 years of diverse experience

Credentials

• Doctor of Optometry (OD) help Doctor of Optometry Doctors of Optometry (O.D.s/optometrists) are the independent primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.

Education and Training

• Dr. Gary F Salak attended and graduated from Pennsylvania College Of Optometry in 1996.
• NPI #: 1285684761
• NPI Enumeration Date: Friday, May 12, 2006

Quality Reporting

• eRx - He does not participate in the Medicare Electronic Prescribing (eRx) Incentive Program.
• PQRS - He does not report Quality Measures (PQRS). The Physician Quality Reporting System (PQRS) is a Medicare program encouraging health care professionals and group practices to report information on their quality of care. Quality measures can show how well a health care professional provides care to people with Medicare.
• EHR - He does not use electronic health records (EHR). The Electronic Health Records (EHR) Incentive Program encourages health care professionals to use certified EHR technology in ways that may improve health care. Electronic health records are important because they may improve a health care professional's ability to make well-informed treatment decisions.
• MHI - He does not commit to heart health through the Million Hearts initiative. Million Hearts is a national initiative that encourages health care professionals to report and perform well on activities related to heart health in an effort to prevent heart attacks and strokes.
• MOC - He does not participate in the Medicare Maintenance of Certification Program. A "Maintenance of Certification Program" encourages board certified physicians to continue learning and self-evaluating throughout their medical career.

Language Spoken by Dr. Gary F Salak

Medical licenses.

Practice Locations

• Monday: 8:00 AM - 5:00 PM
• Tuesday: 8:00 AM - 5:00 PM
• Wednesday: 8:00 AM - 5:00 PM
• Thursday: 8:00 AM - 5:00 PM
• Friday: 8:00 AM - 5:00 PM
• Saturday: Closed
• Sunday: Closed

Contact Dr. Gary F Salak by phone: (570) 843-6054 for verification, detailed information, or booking an appointment before going to.

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Raymond Paz, MD

Dr. Raymond Paz is a Board Certified Family Physician and a Certified Medical Examiner for the U.S. Department of Transportation. He has been providing healthcare services on the Palouse since 2008.

Dr. Paz received his bachelor’s degree from the University of California-San Diego in Biochemistry and Cell Biology and his Doctorate of Medicine from the University of Iowa Carver College of Medicine. Dr. Paz pursued broad training in the specialty of Family Medicine at Idaho State University’s Family Medicine Residency Program, where he also served as Chief Resident.

Dr. Paz chose Family Medicine because it allows him to provide comprehensive healthcare to patients throughout all stages of life. He performs office based procedures and surgeries, cares for patients with acute and chronic health conditions, while providing preventive healthcare for men, women, and children, including DOT physicals.

Sara Presol, FNP-C

Sara Presol is a Board Certified Family Nurse Practitioner. Sara obtained her BSN degree from Lewis-Clark State College and her Masters of Science in Nursing from Gonzaga University.

Sara enjoys the diversity of primary health care, and has clinical experience in acute and chronic care management. She is passionate about helping individuals with weight management, preventative health and is highly committed to providing optimal care to our community. Sara and her husband were both raised in Moscow and are deeply rooted to the community, raising their two amazing daughters. The Presol family own and operate a Certified Organic garlic farm and enjoy everything outdoors.

Jessica Cruz, PA-C

Jessica Cruz began her career in healthcare as a Certified Athletic Trainer after graduating, Suma Cum Laude, from California State University — Fresno with a undergraduate degree in Kinesiology. Jessica went on to earn her master’s degree from Idaho State University, though if you ask her she is a Vandal at heart.

Having grown up in a small agricultural town in California, Jessica and her husband knew they wanted to provide a similar experience for their own children, where they could get to know their neighbors and be part of a tight-knit community. Taking the time to know her patients has been Jessica’s priority and has aided her in providing the best healthcare treatment possible.

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How to Succeed as a Locum Tenens Professional in New Jersey

July 24, 2024

Locum tenens assignments in New Jersey provide flexible career development opportunities for advanced care providers in a wide range of specialties. 

Whether you are looking for a full-time nurse practitioner job or a part-time physician assistant position at a family practice, you’ll find plenty of options in New Jersey’s bustling healthcare market. Here’s everything you need to know about succeeding when participating in locum tenens in New Jersey.

Table of Contents

• New Jersey's Healthcare Landscape

Locum Tenens Salaries in New Jersey

Requirements for locum tenens in new jersey, lifestyle and living in new jersey.

• Tips for a Successful Assignment

New Jersey’s Healthcare Landscape

Job seekers looking for locum tenens roles often consider New Jersey due to the state’s dynamic healthcare landscape. There are a plethora of locum tenens jobs due to the market’s growth rate – the market is expected to grow 8% between 2024 and 2030. Here’s an overview of what you can expect when looking for staffing opportunities in New Jersey.

Overview of Healthcare Facilities

New Jersey boasts diverse healthcare facilities, ranging from large teaching hospitals and research institutions to community clinics and private practices. Areas like Newark, Atlantic City, Trenton, and parts of northern New Jersey are particularly appealing to individuals looking for new jobs.

The state is home to numerous top-ranked hospitals and a robust network of outpatient centers, urgent care facilities, and specialized treatment clinics. Regardless of your specialty or career goals, you will have plenty of opportunities. 

You can also explore opportunities in neighboring areas like Philadelphia and New York, which are a short commute from New Jersey.

Demand for Locum Tenens in New Jersey

The market for locum tenens in New Jersey benefits from the area’s growing population and high demand for skilled medical professionals. The area is also contending with a severe physician and nursing shortage.

According to recent estimates from the American Board of Family Medicine, New Jersey has the lowest concentration of family physicians in the nation . There are just 17 primary care physicians per 100,000 residents.

New Jersey is also in dire need of nurses, with experts predicting that the state will be short over 11,000 registered nurses by 2030 . There are already tons of travel nurse positions in the state, with more postings likely to emerge as the shortage worsens.

Specialties in High Demand

Family medicine and nursing roles are in the highest demand. There are also plenty of job alerts for care providers who specialize in:

• Emergency medicine
• General surgery
• Gastroenterology
• Anesthesiology

Due to the shortage, many of these job descriptions boast competitive compensation and flexible 12-hour shifts. You’ll have no problem finding the right locum tenens opportunity for your career goals.

Locum tenens salaries vary based on where you work, what specialty you operate in, and seasonal demand fluctuations. 

As you conduct your job search, carefully review all benefits and compensation being offered, including salary, housing allowance, and other perks. Many facilities are offering additional benefits to fill vacancies as soon as possible.

Salary Expectations by Profession

Your salary expectations will vary depending on what specialty you operate within and the nature of the position. You may also be eligible for additional compensation for working nights and weekends as opposed to only working weekdays.

A physician’s assistant can earn approximately $115-$130 per hour by working as a locum tenens in New Jersey. The pay for PAs is relatively similar throughout most of the state.

Conversely, physician pay varies greatly depending on your specialty. Locum tenens pediatricians typically earn between $168,000 and $190,000 annually . Top earners bring in over $277,000 annually.

General surgeons earn much more. Locum tenens positions in New Jersey pay approximately $239,000-$267,000 annually . At the top end, general surgeon locum tenens providers can earn upward of $400,000.

Locum tenens anesthesiologist jobs in New Jersey are about on par with general surgeon pay. Top earners make over $406,000 per year . However, pay is less than the national average. Comparing your earning potential to the national average will help you make informed choices when deciding where to take your talents.

Benefits and Perks for Locum Tenens Providers

Locum tenens providers typically enjoy lots of perks, as recruiters want to entice you to come work at the facilities they have partnered with. Healthcare facilities will often offer add-on benefits like:

• Per diem allowances for meals and housing
• Flat housing fees
• Flexible schedules

Remember, these facilities want you to work for them. That’s why they are offering these extra perks. Keep that in mind when comparing vacancies.

Take time to crunch the numbers on per diem allowances versus flat housing allowances. In some cases, you may find that the per diem benefit puts more money in your pocket. In other instances, the flat rate may be the better choice.

Also, keep in mind that these rates are negotiable. You can ask for additional perks — within reason, of course.

Cost of Living and Its Impact on Earnings

Don’t just look at pay and benefits. Pay close attention to the cost of living as well. The cost of living in New Jersey is 11% higher than the national average. Living in Newark costs 16% more than the national average, which means you’ll pay more to cover rent, food, and transportation.

Speaking of housing, rent and mortgages in New Jersey are 30% higher than the national average. With that in mind, it’s a good idea to research rent options before picking a destination and assignment. 

If the employer is offering a housing allowance, find out whether it’s enough to cover your rent and utilities. If not, make sure you are okay covering the difference.

Before you start applying for locum tenens roles in New Jersey, make sure you meet state license requirements and have all the necessary documentation. Here’s a brief look at what you’ll need.

Licensing Process for New Jersey

Obtaining a medical license in New Jersey involves several steps. Fortunately, the state offers licensure by reciprocity , which means they will issue you a license after they verify that the state where your license originated has requirements that are “substantially equivalent” to current board standards.

You must have been practicing medicine for at least two years within the five years preceding your date of application.

You’ll also need to pay a licensing fee and background check fee. Once the state receives these fees, it will process your application and initiate your background check. The entire process can take a few weeks or more, so make sure to submit your application well before your locum tenens start date.

Credentialing Requirements

The hospital or clinical facility will also need to verify your credentials. They will check the status of various certifications, such as your advanced cardiovascular life support certification. If any of your courses are expired, you may need to renew them before being selected for a locum tenens position.

Carefully review each facility’s credentialing requirements so that you can prevent any delays in your application process. If you partner with GHR Healthcare, we will help expedite these processes so you can quickly make a move to your dream position.

After you’ve addressed the logistical and salary aspects of moving, it’s time to focus on where you’ll live. There are plenty of great living opportunities in New Jersey and lots to do. The key is to find a location that aligns with your transportation needs and personal preferences.

If you plan on relying on public transportation to get around, consider housing near the place you’ll be working. If you are bringing a vehicle with you, you’ll have more flexibility but will also need to ensure the place you move to has adequate parking.

Best Neighborhoods to Live In

New Jersey offers a variety of desirable neighborhoods to suit different lifestyles and preferences. Hoboken is one of the best areas for healthcare providers. It has a vibrant nightlife and proximity to New York City. Princeton has a charming downtown area and top-rated schools.

Montclair is another hot spot. It has plenty of amenities and everything you’d expect from a thriving suburban area.

Activities and Attractions

New Jersey has beautiful beaches along the famous Jersey Shore. There are also lots of state parks for hiking and outdoor activities. If you are more interested in cultural attractions, consider one of the state’s many museums, theaters, and historic sites.

The Liberty Science Center is a family-friendly destination that will satiate your passion for learning. The city is also close to New York City and Philadelphia, allowing you to branch out.

Dining and Nightlife

New Jersey’s dining scene is diverse and vibrant, offering everything from high-end restaurants to classic diners. The state is famous for its Italian cuisine, especially in areas like Hoboken and Jersey City.

If you venture out to coastal cities like Cape May and Point Pleasant, you’ll enjoy some of the best seafood the state has to offer. Many restaurants in the area often have live music as well.

Tips for a Successful Locum Tenens Assignment in New Jersey

Here are a few more tips to make your time in New Jersey especially successful.

Preparing for Your Assignment

To ensure a smooth transition to your new home, it’s important to prepare thoroughly. This includes understanding the specific requirements of your assignment and familiarizing yourself with the area you’ll be moving to.

Arrange housing and transportation in advance to avoid any last-minute delays or cancellations. Make sure to connect with your hiring agency to set expectations for your role.

Adjusting to a New Workplace Environment

Adapting to a new workplace can be challenging, but there are strategies to make the transition easier. Start by learning about the facility’s policies and procedures, and take the time to meet your colleagues and build rapport. Being open to feedback and flexible in your approach will help you step right into the new environment.

Networking and Professional Development

Locum tenens assignments offer excellent opportunities for networking and professional growth. Take advantage of these assignments to meet new colleagues and learn from different healthcare systems. A strong professional network can set the stage for a long and successful career.

Why Locum Tenens in NJ Is So Popular

New Jersey has tons of job opportunities for healthcare professionals in a variety of specialties. The competitive pay and unique geographic position make it a desirable location if you want to develop new skills and further your career.

If you’re interested in locum tenens in New Jersey, explore job opportunities . Once you’ve found what you’re looking for, make sure your licensing and credentials are in order, and then choose where you’ll live and enjoy expanding your career in New Jersey.

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Steward Health Care fails to secure bids on Ohio, Pennsylvania facilities

Embattled Steward Health Care has canceled auctions for its hospitals in Ohio and Pennsylvania after it did not receive qualified bids for those facilities, according to a court filing.

The health system said in a document filed Sunday with a bankruptcy court in Texas that it is working to determine alternatives for those facilities, and expects to make an announcement at a later date. It had initially set a bid deadline for June 24 for these assets, which was later pushed back to July 15.

Steward filed for chapter 11 bankruptcy in the Southern District of Texas in May.

The system did reveal that it found potential buyers for one facility in Arkansas and another in Louisiana. Pafford Health Systems bid on the Arkansas-based Wadley Regional Medical Center for $200,000, while AHS South LLC is seeking to buy Lousiana hospital Glenwood Regional Medical Center for $500,000.

The buyers would have to take on the facilities' liabilities, but would not be held to a rental agreement with Medical Properties Trust, Steward Health Care's landlord.

The bid deadlines have been pushed back as high-profile potential sales have fallen through. Optum, for instance, had signed on to buy Steward's physician group before walking away from the deal amid mounting criticism from lawmakers and others.

A hearing over these potential sales will be held on July 31, according to the court filing.

Meanwhile, the Senate Health, Education, Labor and Pensions (HELP) committee will hold a bipartisan vote on Thursday to determine whether to subpoena Steward CEO Ralph de la Torre to compel him to speak at a hearing on the health system's struggles in September.

The HELP Committee previously invited de la Torre to testify but he declined, according to a statement from Chair Bernie Sanders, I-Vt., and Ranking Member Bill Cassidy, R-La.

Nick Caito/NAHC

Why Home Health Providers Should Expect To See A ‘Less Draconian’ Final Payment Rule

As home health providers continue to digest the proposed payment rule for 2025 , National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule.

“We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.”

Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.

“Our focus more than anything else is remedy coming by way of Congress,” Dombi said. “If we run the clock back 365 days, we had a Congress that was telling us, very overtly, ‘We will not help you.’ They were telling us that because they believed [providers] were making too much profit in the Medicare program. They were not understanding how the business runs. They weren’t understanding how any margin [providers] got was subsidizing other government programs like Medicaid and Medicare Advantage. They now understand it.”

Dombi credits a meeting the organization had with Sen. Ron Wyden (D-Ore.), which took place in Portland, Oregon and included five home health agency representatives from the state.

“Senator Wyden asked the question: ‘MedPAC says your margins average 22%, are those numbers wrong or has something changed?’” Dombi said. “One agency representative immediately spoke up and said, ‘the numbers are wrong and things have changed for the worse.’ He started explaining what happened within his home health agency. Now Senator Wyden is working with us to help us bring about some positive legislative changes.”

Dombi noted that there is already pending legislation.

Still, working with Congress isn’t the only way NAHC plans to address the issue. The organization is still moving forward on its plan to sue the Department of Health and Human Services.

“The action plan continues with this litigation,” Dombi said. “This litigation does not give us quick remedies. My estimate is if we succeed in the first round, we will be facing an appeal by the government. If we lose, they’ll be facing an appeal. Then there’s still the step above that — the U.S. Supreme Court. This kind of litigation may take many years to get through.”

However, Dombi believes that last month’s Supreme Court decision, which struck down the Chevron doctrine , may help NAHC’s lawsuit.

The proposed payment rule wasn’t the only issue highlighted during Dombi’s rundown of legislative and regulatory updates, however.

80-20 silver lining

The “ Ensuring Access to Medicaid Services ” rule also came under fire, specifically its 80-20 provision, which is controversial among providers.

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Dombi pointed out that caregivers should receive higher compensation for their work, but NAHC doesn’t believe that the 80-20 provision is the right method to achieve this.

“We’re in agreement that the direct care workforce is underpaid and underappreciated,” he said. “We don’t agree that the solution is to say, ‘You have to pay 80% of your payment rate as compensation to that workforce,’ when the states are paying you at such an abysmal level for the service. There’s nothing in this rule that increases payment rates for the providers of services.”

There is, however, a silver lining to the provision. It doesn’t require compliance for the first six years.

“In Washington circles, giving that much of a glide path for something to take effect is almost a death sentence, so we expect that there’ll be a number of changes or it will be abandoned along the way,” Dombi said.

Despite the 80-20 provision, Dombi explained that the rule had other aspects that would be beneficial to providers , including more accountability for the states regarding payment rates.

Personal care sees more regulation

Dombi warned private-duty personal care providers not to fall into the trap of viewing the industry as being free of regulation.

“They may not be getting paid by federal or state governments, but they’re subject to a lot of rules and regulations, particularly under the Department of Labor,” he said.

Specifically, personal care is an industry that the department has its eye on when it comes to compliance with the Fair Labor Standards Act.

Aside from the DOL’s personal care focus, The Federal Trade Commission (FTC) also finalized a rule that effectively banned non-competes . Though this impacts all industries, Dombi noted that home care companies often rely on non-competes.

More recently, a federal court in Texas temporarily blocked the FTC’s non-compete ban. Dombi advised providers to follow these updates closely.

Companies featured in this article:

The National Association for Home Care & Hospice

Joyce Famakinwa

Joyce Famakinwa is a Chicago area native who cut her teeth as a journalist and writer covering the worker’s compensation industry and creating branded content for tech companies and startups. When she isn’t reporting the latest in home health care news, you can find her indulging in her love of vintage clothing, books, film, live music, theatre and reality tv.

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