Medicare Compliance & Reimbursement

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 things like deductibles, coinsurance or copayments — but it happens frequently, the agency warns.

“Many beneficiaries are unaware of the billing restrictions (or concerned about undermining provider relationships) and simply pay the cost-sharing amounts,” CMS says. “Others may experience undue distress when unpaid bills are referred to collection agencies.” Not only is it inappropriate to balance bill these patients, but you are prohibited from billing them for these amounts even if you don’t participate with Medicaid. If you are a Medicare provider, you’re subject to the balance billing prohibition, CMS says.

Resource: For more on this issue, see the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1128.pdf.