Complete Story
07/06/2017
CMS Announces...
Qualified Medicare Beneficiary Indicators on Remittance Advice
Implementation date is set for October 2, 2017, for CMS/MACs to list the Qualified Medicare Beneficiary Indicators on the remittance advice.
QMB is a Medicaid program that assists low-income beneficiaries with Medicare premiums and cost-sharing.
Change Request (CR) 9911 modifies the Medicare claims processing systems to help providers more readily identify the Qualified Medicare Beneficiary (QMB) status or each patient and to support providers' ability to following QMB billing requirements. Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims. CR 9911 adds an indicator of QMB status to Medicare's claims processing systems.
The QMB indicators will initiate new messages on the Remittance Advice that reflect the beneficiary's QMB status and lack of liability for Medicare cost-sharing with three new Remittance Advice Remark Codes (RARC) that are specific to those enrolled in QMB. As appropriate, one or more of the following new codes will be returned:
- N781 - No deductible may be collected as patient is a Medicare/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments.
- N782 - No coinsurance may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments.
- N783 - No co-payment may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments.
In addition, the MACs will include a Claim Adjustment Reason Code of 209 ("Per regulatory or other agreement. The provider cannot collect this amount fro the patient. However, this amount may be billed to the subsequent payer. Refund to patient if collected. (Use only with Group code OA (Other Adjustment))).
Finally, CR 9911 will modify the Medicare Summary Notice to inform beneficiaries if they are enrolled in QMB and cannot be billed for Medicare cost-sharing for covered items and services.
For more information check out MNL MM9911.
