Qualified Medicare Beneficiary (QMB)- To Bill or Not to Bill?

The new QMB Indicators rolled out on July 1, 2018, and you probably have been busy implementing a process to identify the QMB status of your Medicare patients prior to billing. It seems everyone is focused on not billing QMBs. In fact, some providers have created office policies that direct employees to NEVER bill QMBs for fear of violating Federal Law.

While you were implementing processes to avoid billing QMBs, KMC University researched ways to protect your reimbursements. At KMC University we are aware of how hard you work for your reimbursements, and we never want you to leave money on the table. In an effort to clarify what you can and cannot charge a QMB, we connected with CMS directly. We asked about billing for services that are considered medically unnecessary (such as maintenance care) and other procedures that are never covered by Medicare.

Test your QMB knowledge! Ask yourself,

• Would you charge a QMB patient for maintenance care?
• What about statutorily excluded services—the things Medicare NEVER covers—are you able to bill those to a QMB patient?
• Is there ever a time when it is okay to bill copays to a QMB?

CMS responded to our inquiry and we have added their responses to our Medicare Verification FAQs.