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CMS Schedules Session on QMB Billing Compliance

Medicare providers and suppliers may not bill Medicare recipients in the Qualified Medicare Beneficiary (QMB) program for Medicare deductibles, coinsurance, or copays, although 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 is the case, people in the QMB program have no legal obligation to pay Medicare providers for Medicare Part A or Part B cost-sharing.

The Centers for Medicare and Medicaid Services (CMS) has found that in some cases, those in the QMB program are still being wrongly billed, and that confusion about billing rules continues. A fact sheet on the program was issued in March and is available here. CMS experts will be holding a call on June 6th from 1:30 to 3 p.m. to discuss QMB billing requirements and their implications. The discussion will include the July 2018 re-launch of changes to the Medicare remittance advice and November 2017 changes to the HIPAA Eligibility Transaction System (HETS) to identify the QMB status of patients and residents. The call is free but does require participants to register here.

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