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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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…
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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…
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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…
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