Wiki Qualified Medicare Beneficiary program (QMB)

Create Wiki
E

edmedbilling

Contributor
Messages
14
Location
Seattle First Hill Washington
Best answers
0
Hello, we have a patient that is part of the Qualified Medicare Beneficiary program (QMB) from Medicare. How is this program billed?
What happened is they gave us their AARP insurance and no medicare info. We billed AARP and they had a copay now she's asking for a refund.

Do we now bill medicare instead then this program secondly?

Thank you!

Edward Gee
 
A qualified Medicare beneficiary is someone who receives assistance from Medicaid to pay for their Part A and/or Part B Medicare or Medicare Advantage plan.

An important thing to note is that the provider may not transfer any copay,coinsurance or deductible to a QMB patient - even if the provider is non-par with Medicaid.

You will need to verify the correct insurance information and also check to make sure that the patient is still considered QMB. If this is the case, refund the patient, and send the claim to Medicare. When a patient is a QMB, Medicare is always the primary payer. So, bill Medicare and then forward the secondary claim to AARP (unless it is just a Part D plan). If they pay, great, if they don't, you may not collect from the patient and will have to w/o the balance.

Here are some FAQ on the QMB program:
https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-09-19-QMB-FAQ.pdf

Jennifer Ziegler, CMRS, CPCO
Velocity Medical Billing LLC
 
Last edited:
You must log in or register to reply here.
Top