CMS issues clarification on balance billing prohibition The QMB program is a State Medicaid benefit that covers Medicare deductibles, coinsurance, and copayments. Medicare providers may not balance bill QMB individuals for Medicare cost-sharing. Providers who inappropriately balance bill QMB individuals are subject to sanctions.
People who do medical billing often cite Medicare as being one of the harder types of claims to process. Processing Medicare claims has many steps and once they receive the claim, there are several verifications that they do before they will pay the doctor. Any mistake along the way can result in unpaid or...
Revenue cycle management starts when the patient makes an appointment with the doctor’s office. Then when they come to the visit, they usually pay their co-pay and the office then files a claim for the service. The cycle ends when that claim is paid.
Medical billing is one of the most frustrating and confusing things that doctors and doctor’s offices deal with. There are so many different rules and often, those rules can change which results in incorrect billing, and that leads to unpaid claims and having to resubmit them, which causes more work for the administrative part...