January 2020
Reminder: Medicare Providers May Not Bill Members in the Qualified Medicare Beneficiary Program
Members enrolled in QMB are dual eligible beneficiaries, which means they are eligible for both Medicare and Medicaid. As a State Medicaid benefit, QMB covers these members’ Medicare premiums, deductibles, coinsurance and copayments. QMB members are not responsible for Medicare cost-sharing, or out-of-pocket costs.
Your Responsibility
Providers participating in Blue Cross Medicare AdvantageSM plans may not bill their QMB patients for their services. This is regardless of whether the State reimburses the full Medicare cost-sharing amounts. You must accept Medicare payments and any Medicaid payments provided as payment in full.
Federal Law
Please ensure that you and your staff are aware of the federal billing law and policies regarding QMB. It is against federal law for any Medicare provider, not only those who also accept Medicaid, to bill QMB patients. Per your Medicare Provider Agreement, you may be sanctioned if you inappropriately bill QMB members for Medicare cost-sharing.
Helpful Tips
To avoid billing QMB members, please take these precautions:
- Understand the Medicare cost-sharing billing process
- Be sure your billing software and staff leave QMB members off Medicare cost-sharing billing and related collections efforts
More Information
Call Customer Service at 877-774-8592 to learn more about QMB procedures and ways to identify QMB patients. For more details about QMB, see the Centers for Medicare & Medicaid Services website.
This is a brief description of some of the terms of the Medicare Advantage plans. For more details, please refer to the applicable Medicare Advantage document. The information provided here is only intended to be a summary of the law that have been enacted and is not intended to be an exhaustive description of the law or a legal opinion of such law. If you have any questions regarding the law mentioned here, you should consult with your legal advisor.