Qualified Medicare Beneficiary Program

Lately, I have been receiving questions regarding Medicare beneficiaries who are dually eligible (have Medicare primary and Medicaid secondary) and are enrolled in the Qualified Medicare Beneficiary (QMB) program. Medicare beneficiaries enrolled in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing.

What providers want to know is can they bill the Medicare beneficiary who is enrolled in the QMB program for the 20% co-insurance the Medicare program does not cover as well as any deductible the Medicare beneficiary has not met yet if the Medicaid program does not pay that portion? Below, I will provide answers to some of the more common questions and also provide resources where you can obtain additional information on the QMB program.

Question
What is meant by “dually eligible beneficiaries”?

Answer

Question
What is the purpose of the QMB program?

Answer

Question
Do QMB billing requirements apply to beneficiaries enrolled in all Medicare Advantage
plans?

Answer

Question
If I am not enrolled in my states Medicaid program, can I bill the dually eligible Medicare beneficiary for their 20% co-insurance that traditional Medicare does not pay if they are in the QMB program?

Answer

Question
What if I have a Medicare beneficiary who is enrolled in the QMB program in another state; can I then bill the patient for their 20% coinsurance?

Answer

Question
Can I seek payment for Medicare cost-sharing for QMBs from State Medicaid Programs?

Answer

Question
How will I know if the Medicare beneficiary is enrolled in the QMB program

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Question
How will the Remittance Advice reflect a Medicare beneficiary’s QMB status?

Answer

Question
If I am enrolled in the Medicare program as a non-participating provider, must I accept assignment on a claim for a Medicare beneficiary enrolled in the QMB program?

Answer

Question
Can a Medicare beneficiary enrolled in the QMB program elect to pay their Medicare deductibles, coinsurance, and copays?

Answer

Question
What can happen to me if I accidentally bill and collect monies from a Medicare beneficiary enrolled in the QMB program?

Answer

Question
Where can I find additional information on the QMB program

Answer

I hope you found this article to be informative and helpful to your practice or organization. Thank you for being a Gold Member!