QMB Information Reinstated for Medicare FFS Claims

The Qualified Medicare Beneficiary (QMB) information in the Medicare remittance advice (RA) and Medicare summary  notice is being reintroduced; the issues preventing the processing of QMB cost-sharing claims by states and other secondary payers have been resolved.

The simple fix was to include revised “alert” Remittance Advice Remark Codes in RAs for QMB claims without adopting other RA changes that impeded claims processing by secondary payers.

About the QMB Program

Federal law prohibits providers and suppliers from billing a patient enrolled in the QMB program for Medicare Part A and Part B cost-sharing. They may instead bill state Medicaid agencies for Medicare cost-sharing amounts.

Read the back story here: “CMS Reverts Systems Back to Former RA for QMB Claims”

Processing QMB Claims

Effective July 1, 2018, the RA for QMB claims will retain the display of patient liability amounts needed by secondary payers to process QMB cost-sharing claims. All Medicare fee-for-service systems will cease outputting Claim Adjustment Group code OA Other adjustment with Claim Adjustment Reason Code (CARC) 209, in place of CARCs 1 and 2, as well as CARCs 66, 247, and 248 on the ERAs and on SPRs, as applicable.

Additionally, for QMB claims, the Part A and B shared systems will include the revised Alert RARC N781 in
association with CARC 66 (blood deductible). The revised Alert RARCs are:

• N781 – Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer.
• N782 – Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer.

Source: MLN Matters article MM10433 Revised, March 6, 2018

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Renee Dustman

Executive Editor at AAPC

Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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