Medicare Compliance & Reimbursement

New guidance from CMS reminds providers that just because you send bills to a Qualified Medicare Beneficiaries, doesn’t mean they have to pay them. In fact, they “have no legal obligation to pay Medicare Part A or B deductibles, coinsurance, or copays for any Medicare-covered items and services,” an updated MLN Matters release says.

Reminder: The QMB program, which falls under the realm of Medicaid, was created to “assist low-income beneficiaries with Medicare premiums and cost-sharing.” The feds forbid Medicare Part A and Part B providers and suppliers from billing QMBs. And if you willingly or accidentally bill Medicare for services, you are subject to sanctions under the Social Security Act (see Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), 1866(a)(1)(A), and 1848(g)(3)(A)).

However due to confusion over the QMB billing rules, many providers still send bills to beneficiaries without a thorough understanding of their coverage under the plan. To combat this prevalent problem and federal rebuke, CMS advises in this newest QMB program update that providers install proper compliance protocols as well as communicate with their state Medicaid office to eradicate any issues and recover payment for services rendered.

Find the MLN Matters article SE 1128 at: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1128.pdf.