Medicaid

andersont

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Can someone help clear up some confusion with this please. When I look up benefits for a Medicare/Medicaid patient and they have this "CNP-Categorically Needy Program/QMB-Qualified Medicare Beneficiary-Medicare Only". Does this mean the patient is responsible for the balance after Medicare pays? Thanks
 

ckmiotek

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QMB recipients cover their Medicare Part B premium, deductible, and co-insurances; the patient is not responsible for anything after Medicare processes the claim.

SLMB is the category that only covers the Medicare Part B premium. Meaning the patient is getting their Medicare coverage for free but are responsible for deductible and co-insurances.

Hope this helps.
 

lduquette

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QMB recipients cover their Medicare Part B premium, deductible, and co-insurances; the patient is not responsible for anything after Medicare processes the claim.

SLMB is the category that only covers the Medicare Part B premium. Meaning the patient is getting their Medicare coverage for free but are responsible for deductible and co-insurances.


I'm not the original poster, but this is EXACTLY what I needed to know, thank you!!!
 

Launie75

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QMB- OA code write off

can someone assist me more on this?

someone on this forum stated: "QMB recipients cover their Medicare Part B premium, deductible, and co-insurances; the patient is not responsible for anything after Medicare processes the claim."

who are QMB recipients? I am confused on how they say they cover their part B premium, ded/coin who is covering this, the doctors if the patients are not having to pay them?View attachment mm9911 - QMB Update (002).pdfView attachment mm9911 - QMB Update (002).pdf

I have been seeing this code, but when I log into Palmetto Medicare, there is nothing to indicate that a member is QMB?? Can we still bill to a secondary that they have on file w/us? What if THAT secondary deems PR?

This all seems to have taken effect Oct 1, 2017

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 Medicaid/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.
 

ckmiotek

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Response to Luanie75

QMB Recipients are your patients that are enrolled in both Medicare/Medicaid. "They" cover the premium, deductible, and co-insurance, the "they" is the government. The government is assisting that patient to be enrolled in this plan. This is through the Medicaid program so the program code will only appear when you check eligibility through Medicaid. I have not seen it when you check eligibility through Medicare. So going to Palmetto will not show you that status. Going to Medicaid portal will show you that status.

You are right starting now Medicare is showing on their remittance advise the indicators but they are labeled with the N78 code. So basically you can figure out the recipient status by checking Medicaid eligibility or by reviewing your Medicare Remittance Advice.

Attachment 3165 on your post is actually quite good and says everything it needs to about the program.
 

daedolos

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Thank you, everyone on this thread. I needed some info on this last week and now I can proceed.

Peace
@_*
 
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