The Financial Liability Protection The Advance Beneficiary Notice of Noncoverage (ABN) originated from the Financial Liability Protection provisions of the Social Security Act. The Act protects beneficiaries and doctors from unexpected liability for charges associated with claims that Medicare does not pay. The Financial Liability Provisions include: Limitation on Liability Compliance Mandatory Use of the…
The Advance Beneficiary Notice (ABN) can be one of the most confusing and frustrating elements of the Medicare process. There is significant confusion about the what, why, and how of proper ABN usage. Conflicting information and pervasive misinformation have been widespread throughout the profession for years. This short training is the first step in putting…
Download Reference Documents This page contains helpful tools that provide a deeper dive into the topic of Qualified Medicare Beneficiaries. Here we list timely tools to review, download, and save in your Medicare training documents Cost-Sharing for Medicare Advantage Plans List and Definition of Dual Eligibles Dually Eligible Beneficiaries Under Medicare and Medicaid Prohibition Billing…
Qualified Medicare Beneficiary Billing FAQ’s Q: Can a provider pass on costs related to excluded (non-covered) services to QMBs? A: Yes, in most cases. QMB rules only apply to Medicare COVERED services, so the billing protections do not apply to excluded Medicare covered services. However, if the patient is a QMB Plus (has full Medicaid coverage), coverage may…
What You Should Know Compliant billing of QMBs is a challenge. This is because each state has set its own guidelines for identifying what is included with their zero-cost sharing liability, and how they will communicate to providers the status of dually eligible individuals. Once you have verified the QMB status, it is necessary to…
Confirming QMB Status Medicare Qualified Beneficiaries (QMBs) hold special status when it comes to cost sharing in your office. It’s important to identify them carefully before any financial transactions take place. In 2017 CMS set up a system to help clinics and clearinghouses verify status. The system is called the HIPAA Eligibility Transaction System (HETS)….