Defining QMB The QMB (Qualified Medicare Beneficiary) program is a State Medicaid benefit that supports low-income Medicare beneficiaries through Medicare Part A and Part B premium and cost-sharing discounts and waivers . This includes deductibles, coinsurance, and copays. You will likely have QMB patients seeking treatment in your clinic given the fact that in 2017,…
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This tutorial discusses an important compliance related topic that impacts all clinics that accept and treat Medicare beneficiaries. Sadly, in most clinics, the requirements surrounding a Qualified Medicare Beneficiary (QMB) are often ignored resulting in serious violations of Medicare regulations. NOTE: This tutorial mentions the HIPAA Eligibility Transaction System (HETS) as the source for locating QMB…
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Where to Find Medicare Provider Numbers When a clinic needs to obtain information from Medicare, whether it be verifying primary status or following up on an appeal or reconsideration, the Medicare representative or phone prompt will ask for the Medicare provider number. Staff will hit a dead end if they do not know where to…
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Beyond Traditional Medicare Part B As healthcare costs increase, patients will look for insurance with more benefits and less out of pocket cost. That is why many Medicare beneficiaries look at replacing their traditional Medicare coverage with a replacement plan such as a Medicare Part C also known as Medicare Advantage. These plans are very…
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It’s important to understand the difference between true verification and an eligibility check. There are so many layers to understanding the coverage a Medicare patient has that you must follow each step methodically. Whether the patient has Medicare Part B or Medicare Part C is the first critical bit of information you must be aware…
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Commercial Health Insurance FAQs Q: What is a subscriber? A: The person who holds the insurance from the employer in his/her name. S/he is the person responsible for paying the insurance premium. If it is an employer plan, the employee is the subscriber. Q: Why do I need to verify insurance? A: To ensure that…
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