Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed
AI Summary
Providers participating in Blue Cross Medicare Advantage plans are prohibited from billing patients enrolled in the Qualified Medicare Beneficiary (QMB) program for any cost-sharing, deductibles, coinsurance, or copayments. QMB is a federal Medicare savings program that covers all Medicare Advantage cost-sharing for dual eligible beneficiaries.
Action Required
Immediately: Billing team must identify QMB members by looking for 'Blue Cross Medicare Advantage Dual Care' on member ID cards and verify QMB status through Availity Essentials. Update billing software to automatically exclude QMB patients from all Medicare Advantage cost-sharing billing and collections efforts. Review and remove any existing QMB patients from current collections. Train all staff on federal billing law prohibiting QMB patient billing. Failure to comply may result in federal sanctions per Medicare Provider Agreement.
Plan Types
Medicare Advantage
States
TX
Specialties
all-specialties