QMB question


Spartanburg, SC
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I work for a provider who, up until late last year when I started in the department, had no idea about QMB and prohibition against balance billing these patients. Up until then, if a patient had Medicare & Medicaid, they told the patient we were not in network with Medicaid (which is true, we aren't) and never checked to see if the patient was QMB. A lot of these people actually were QMB and for literally years have been charged their Medicare deductible and 20% coinsurance. I've corrected these as I come by them and adjusted the accounts but I am thinking that we technically have to refund these patients for what they've paid so far as well, not just adjust their balance. I've gotten some push back from my employer about this, they really hate to refund, but this is an issue with legal implications, correct? We cant legally keep these payments when we should not have charged them in the first place, correct? I've only been working in billing and insurance about 6 months so I don't want to overstep my boundaries but right is right. I'm interested in your thoughts, if you've encountered similar issues and how you handled them and if I am understanding the policy correctly. Thanks!!