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CMS call to clarify qualified Medicare beneficiary (QMB) program billing requirements

May 10, 2018
The Bottom Line

On Wednesday, June 6, from 1:30 to 3:00 pm ET CMS experts will discuss the QMB billing requirements and their implications. The call will also discuss the July 2018 re-launch of changes to the remittance advice and November 2017 changes to the HIPAA Eligibility Transaction System (HETS) to identify the QMB status of a facility’s patients and exemption from cost-sharing.

Medicare Part A and B providers, medical billing specialists, practice administrators, IT vendors, health care industry professionals, and other interested stakeholders are encouraged to attend.

People with Medicare who are in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. In 2016, 7.5 million people (more than one out of eight people with Medicare) were in the QMB program.

Billing requirements affecting people in the QMB program include:

  • Medicare providers and suppliers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. Under some circumstances, federal law lets states limit how much they pay providers for Medicare cost-sharing. Even when that's the case, people in the QMB program have no legal obligation to pay Medicare providers for Medicare Part A or Part B cost-sharing.

  • Despite these billing rules, our July 2015 study ("Access to Care Issues Among QMBs") found that those in the QMB program are still being wrongly billed and that confusion about billing rules continues. We're sharing this information to help you understand the QMB program and its billing rules.

Click here to register for the event.

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