What is the consequence of a physician not signing a participating agreement with Medicare?

When a physician does not sign a participating agreement with Medicare, they essentially opt out of the Medicare program's participating provider status. This decision impacts their reimbursement structure significantly. By not participating, the physician may not receive full payment from Medicare for the services they provide. Non-participating providers are allowed to charge patients more than the Medicare-approved amount, but they may only receive a limited reimbursement from Medicare, typically at a lower rate than participating physicians.

In this context, the correct answer emphasizes the financial implications of not signing the agreement, as the physician risks reduced reimbursement and potential issues with billing patients for the balance. Other options do not correctly capture the primary consequence of the situation: while patient satisfaction and the management of fees are important, they do not directly address the payment structure and reimbursement risks associated with non-participation in Medicare.