This short training solidifies some of the most common differences between coverage for Chiropractic care, and coverage outside of the profession. This is an excellent short training to ensure that all team members are aware of this important payer class and how to handle it properly.
This short training provides an overview of the concept of QMB. These patients are entitled to different rules within the Medicare process and the collection of copayments and deductibles. It’s an area where a misstep can lead to major compliance issues. Make sure all team members are aware of this important payer class and how…
Types of QMBs The Medicare Savings Programs (MSPs) was developed to assist low-income Medicare beneficiaries. Individuals who qualify for this assistance are often referred to as Dual Eligibles. All dual-eligible beneficiaries qualify for full Medicare benefits, but the extent or level of benefits for which they are eligible under Medicaid can vary. This is often…
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)….
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…
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…