The Center for Medicare and Medicaid Services (CMS) is restarting an initiative designed to prevent providers from illegally billing certain Medicare beneficiaries. Federal law prohibits Medicare providers and suppliers from directly billing an individual enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare Part A and Part B.
The QMB program is a State Medicaid benefit that assists low-income Medicare beneficiaries with Medicare Part A and Part B premiums and cost-sharing (deductibles, coinsurance, and copays). In 2015, more than 10% of beneficiaries were enrolled in the QMB program.
CMS first launched this effort last year after receiving reports that providers were billing coinsurance costs for patients who were dually eligible for Medicare and Medicaid and enrolled in the QMB program. Patients either ended up in debt collection for medical bills they were never supposed to receive or paid the amounts out of fear of losing access to care.
CMS announced last year that it would attach an alert on billing notices that would indicate a person is in the QMB program and thus has zero cost-sharing responsibility. However, a few weeks later the agency halted the effort after learning the notices would create a technical issue wherein claims for QMB beneficiaries would not get paid by state Medicaid agencies and other payers secondary to Medicare, such as Tricare.
After working out system glitches, CMS will restart the program on July 1, 2018. Providers should henceforth see an alert noting a patient’s enrollment in the QMB program and should not be billed.
For questions regarding the Qualified Medicare Beneficiary program, contact Frier Levitt today to speak to an attorney.
