Prohibition on Balance Billing QMB Patients

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.

Despite federal law, erroneous balance billing of QMB individuals persists.  Many beneficiaries are unaware of the billing restrictions (or concerned about undermining provider relationships) and simply pay the cost-sharing amounts.  CMS recently published an article update to remind providers that they may not bill QMB individuals for any cost-sharing amounts.

See the full article here https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1128.pdf