Qualified Medicare Beneficiary Billing Requirements
The Qualified Medicare Beneficiary (QMB) program provides help with Medicare premiums and cost-sharing for enrolled individuals. More than one out of eight people with Medicare are in the QMB. Medical providers are prohibited by federal law from billing people in the QMB program for Medicare deductibles, coinsurance, or copays. Providers may bill state Medicaid programs for those costs. Providers are subject to sanctions if they inappropriately bill those enrolled in the QMB program. Therefore, it is important for clinicians to implement processes to ensure that they comply with QMB billing requirements.
Providers should regularly identify the QMB status of Medicare beneficiaries in their care before billing for services. Medicare provides several resources to aid clinicians in this process.
- HIPAA Eligibility Transaction System (HETS) – This application allows providers to check updated Medicare beneficiary eligibility to prepare claims and bill services appropriately.
- Medicare Remittance Advice (RA) – Providers should check their Medicare RA. The Centers for Medicare & Medicaid Services (CMS) has reintroduced the QMB information on the remittance advice.
- Michigan Beneficiary Eligibility Verification – Providers should also check state automated Medicaid eligibility verification systems.
Billing errors occur and should be corrected as soon as possible. If a QMB participant is incorrectly billed, the charges should be recalled and all invalid charges paid should be refunded.
At Yeo & Yeo Medical Billing & Consulting, we help our clients bill beneficiaries correctly for services and ensure that their practices comply with QMB billing requirements. Please contact Yeo & Yeo Medical Billing & Consulting with questions.