Medicare Replacement Plans

 Download Infographic To expand on your knowledge of Medicare Part C (Advantage) plans, also known as replacement plans, this resource calls out various facts to be aware of as you develop your Medicare education. Medicare Replacement Plans Note:  If the provider is not enrolled in the patient’s Part C plan, the provider may feel they...
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FAQ-What You Need to Know About QMBs & ABNs

QMBs & ABN FAQ’s Q: What is a QMB? Why do I need to know if a Medicare beneficiary is a QMB before billing? A: The QMB (Qualified Medicare Beneficiary) program is a State Medicaid benefit that guides low-income Medicare beneficiaries through Medicare Part A and Part B premiums and cost-sharing (this includes deductibles, coinsurance,...
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Medicare Advantage & FDR

First Tier, Downstream, or Related Entity FDR is a Centers for Medicare and Medicaid Services (CMS) acronym for First tier, Downstream, or Related entity. A First Tier Entity is any party that enters into a written arrangement (acceptable to CMS) with a Medicare Advantage (MA) organization to provide administrative or health care services to a...
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FAQ-Medicare Verification

Medicare Verification FAQs Q: I called to verify Medicare for a patient and was asked for a PTAN number. What is it & why don’t I have one? A: Medicare Providers are issued Provider Transaction Access Numbers (PTANs) for each place they work. The PTAN identifies the person that renders services to Medicare Beneficiaries in...
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Qualified Medicare Beneficiaries (QMB) Reference Documents

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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FAQ-Billing QMBs

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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