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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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…
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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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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…
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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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