CMS Suspends Updates to RA & MSNs for QMB Claims

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On October 2, 2017, the Provider Remittance (RA) and the Medicare Summary Notice (MSN) for QMB claims began identifying the QMB status of beneficiaries’ and reflecting their zero cost-sharing liability.  The RA changes caused unforeseen issues which affected the processing of QMB cost-sharing claims by States and other payers secondary to Medicare.

In order to address some of the unanticipated challenges, beginning December 8, 2017, CMS will temporarily suspend the system changes, reverting back to the previous display of beneficiary responsibility (deductibles, coinsurance, and co-pays).  Additionally, Medicare RA and MSNs will not include QMB information during the temporary suspension. CMS anticipates reintroducing QMB information in the RA and MSN in 2018.

Policy clarifications on QMB billing requirements:  

All Original Medicare and MA providers and suppliers–not only those that accept Medicaid–must abide by the billing prohibitions.

Individuals enrolled in the QMB program retain their protection from billing when they cross State lines to receive care. Providers and suppliers cannot charge individuals enrolled in QMB even if their QMB benefit is provided by a different State than the State in which care is rendered.

Note that individuals enrolled in QMB cannot elect to pay the Medicare deductibles, coinsurance, and copays. However, a QMB who also receives full Medicaid may have a small Medicaid copay.

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