tci Medicare Compliance & Reimbursement - 2016 Issue 4

Industry Note: CMS: Stop Balance Billing QMB Patients

If you see qualified Medicare beneficiaries (QMBs) — those patients who are eligible for both Medicaid and Medicare — then you should remove the phrase “balance billing” from your vocabulary, at least for your QMB patients. That’s the word from a recent MLN Matters article on the subject. “Despite federal law, erroneous balance billing of QMB individuals persists,” the Centers for Medicare & Medicaid Services (CMS) says in MLN Matters article SE 1128, which the agency revised on Feb. 4. Because QMB patients are exempt from Medicare cost-sharing, you should never balance bill them for...

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