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Industry Note: CMS Cracks Down on Medicare Providers Caught Overcharging Individuals in QMB
As Medicare shifts from fee-for-service and instead focuses on quality, value-based care under MACRA, CMS continues to push through mandates that protect the beneficiary from nefarious providers and suppliers.
In a Nov. 18, 2016 MLN Matters article (MM 9817), a change request was made concerning keeping in compliance when billing a Qualified Medicare Beneficiary (QMB). The initiation of the QMB program, which falls under the realm of Medicaid, was to “assist low-income beneficiaries with Medicare premiums and cost-sharing.” CR 9817 urges MACs to send out compliance letters to providers who persist in overbilling QMBs.
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