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CMS Reintroduces QMB Information on Medicare RA

Effective July 2018, the Centers for Medicare and Medicaid Services (CMS) will reintroduce Qualified Medicare Beneficiary (QMB) information on the Medicare Remittance Advice (RA). Similar changes made to the RA last fall resulted in billing disruptions and were suspended in December 2017. CMS has resolved the issues and is once again adding QMB information to the RA. Providers and suppliers who submit Medicare Part A or B claims should ensure that their billing staff are aware of these changes.

The changes are meant to address CMS concerns that providers were not identifying individuals in the QMB program and, as a result, were subjecting them to cost-sharing. QMB is an eligibility category under the Medicare Savings Program and provides Medicaid coverage of Medicare Part A and Part B premiums and cost-sharing to low-income Medicare beneficiaries. The changes simply make it easier for providers to comply by updating CMS systems to help providers to identify a patient’s QMB status and exemption from cost-sharing.

In addition to the RA change, starting July 2, 2018, Medicare Summary Notices (MSNs) will clearly identify if and when the beneficiary was enrolled in the QMB program and will accurately reflect the beneficiary’s cost-sharing liability ($0 for the period enrolled in the QMB program).

A CMS presentation detailing the changes is available here, a set of Frequently Asked Questions is posted here, and a Medicare Learning Network (MLN) article is here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841