CMS Updates QMB Indicator in Medicare Fee-for-Service Claims Processing System

March 2017 ~

Effective date: Claims processed on or after October 2, 2017

Implementation date: October 2, 2017

CMS has modified the Medicare claims processing systems to help providers more readily identify the Qualified Medicare Beneficiary (QMB) status of each patient and to better support providers.

According to Change Request (CR) issued last month, CR 9911 modifies the Medicare claims processing systems to help providers more readily identify the QMB status of each patient and to support providers’ ability to follow QMB billing requirements.

CR 9911 adds an indicator of QMB status to Medicare’s claims processing systems. This system enhancement will trigger notifications to providers (through the provider remittance advice) and to beneficiaries (through the Medicare summary notice) to reflect that the beneficiary is enrolled in the QMB program and has no Medicare cost-sharing liability.

This change impacts physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries, including Home Health & Hospice MACs and Durable Medical Equipment MACs. Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims.

For more information, refer to MLN Matters® Number: MM9911.

 

Source(s): CMS;

 

 

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