Are you confused? Masters of texting abbreviations or parents of teenagers, probably get most of it:
By The Way, In Case You Missed It, For Your Information review the rules to bill Qualified Medicare Beneficiaries.
You might want to read this ASAP because if you get a compliance letter from CMS, you might say OMG.
On November 4, 2016, CMS issued Medicare Learning Network Matters Article MM9817 “Issuing Compliance Letters to Specific Providers and Suppliers Regarding Inappropriate Billing of Qualified Medicare Beneficiaries (QMBs) for Medicare Cost-Sharing”. The new policy is set to take effect March 8, 2017.
5 Basics Facts About QMB:
1. QMB is a Medicaid program for low-income beneficiaries to help cover Medicare premium and cost-sharing.
2. Federal law prohibits providers/suppliers from charging QMBs for Medicare A and B deductibles,
coinsurance, and copayment amounts.
3. Change Request (CR) 9817, instructs MACs to notify providers/suppliers to refund any erroneously
collected payments and/or recall any improper QMB billing.
4. State Medicaid programs are liable to pay QMBs cost sharing, however federal law allows states to limit
payment to the lesser of Medicare cost sharing amount or difference between Medicare paid amount and
the Medicaid fee schedule amount.
Example: CPT code 99215
$150.00 billed to Medicare
Medicare Approved $100 and paid $80
Balance billed to Medicaid $20
Medicaid Rate $50
Medicare has already paid more than Medicaid, no $0 payment from Medicaid.
5. Providers/suppliers must accept the Medicare and Medicaid payment, even if $0, as full payment with one
exception: Medicaid cost-sharing can be passed onto the QMB.
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Change Request (CR) 9817 was prompted by a 2015 study where erroneously billing was identified. This indicated potential confusion about QMB billing rules.
Educational materials were made available to Medicare beneficiaries in September 2016. When beneficiaries are unsuccessful in resolving the billing issue directly with their provider, they are encouraged to contact the Beneficiary Contact Center.
Those providers/suppliers that are reported will receive the compliance letters. Beyond receiving the letter, a provider/supplier could also suffer sanctions as this is considered a violation of their Medicare Provider Agreement.
HTH (hope this helps) keep you out of hot water!
