In a recent Medicare Learning Network Matters (pdf) article, CMS reminded hospitals and other Medicare providers that they cannot bill qualified Medicare beneficiaries for Medicare cost-sharing.
QMBs are people who are entitled to Medicare Part A and are eligible for Medicare Part B, have incomes below 100 percent of the federal poverty line and have been determined as QMB-eligible by their state Medicaid agency. Billing QMBs for Medicare cost-sharing, including deductibles, coinsurance and copayments, is known as "balance billing."
In these instances, Medicaid pays the Medicare Part A and B premiums, deductibles, coinsurance and copayments for QMBs. CMS recommended providers take four actions to understand the billing process for QMBs further:
1. Determine if the state has electronic crossover processes in place with the Medicare coordination of benefits contractor.
2. Recognize all state-imposed requirements and the provider registration process to be entered into the state payment system.
3. Understand the specific requirements for provider registration in the state.
4. Contact the state's Medicaid agency to determine the process to begin submitting claims and receiving payment.
QMBs are people who are entitled to Medicare Part A and are eligible for Medicare Part B, have incomes below 100 percent of the federal poverty line and have been determined as QMB-eligible by their state Medicaid agency. Billing QMBs for Medicare cost-sharing, including deductibles, coinsurance and copayments, is known as "balance billing."
In these instances, Medicaid pays the Medicare Part A and B premiums, deductibles, coinsurance and copayments for QMBs. CMS recommended providers take four actions to understand the billing process for QMBs further:
1. Determine if the state has electronic crossover processes in place with the Medicare coordination of benefits contractor.
2. Recognize all state-imposed requirements and the provider registration process to be entered into the state payment system.
3. Understand the specific requirements for provider registration in the state.
4. Contact the state's Medicaid agency to determine the process to begin submitting claims and receiving payment.
Related Articles on Hospital Billing:
CMS Shelves RAC Prepayment Review Demonstration
Money Matters: How the Hospital Revenue Cycle Impacts Patient Satisfaction
Survey: 21% of Patients Fully Satisfied With Hospital Billing Process