Dual Eligible Clients Balance Billing

Dual Eligible Clients Balance Billing

This post will give brokers some important information about Dual Eligible Clients Balance Billing.

Medicare Providers are not permitted to bill beneficiaries who are enrolled in the QMB program.  The QMB is a Medicare savings program that exempts Medicare beneficiaries from Medicare cost-sharing liability.  This rule affects all Medicare physicians, providers as well as suppliers.  This also includes providers that serve beneficiaries enrolled in original Medicare or a MA (Medicare Advantage plan).

In fact, any Medicare beneficiary who is part of the QMB Program, does not have any legal obligation to pay any Medicare Part A or B deductible, coinsurance or co-pays for any Medicare approved expense.  Providers must check a patient’s QMB status before they bill them. Providers MUST take steps to comply with the QMB billing requirements.  This will ensure that QMB members who are clients do not receive any bill in error.  These individuals are exempt from paying any and all parts of approved Medicare charges.

If a provider mistakenly bills a client who is enrolled in the QMB program, they should recall the charges.

This includes referrals to collection agencies.  The provider should refund any and all invalid charges that the member has paid. This rule applies to ALL original Medicare and MA providers; not only providers that accept Medicaid.  Any provider who has charged an individual who participates in the QMB program will be subject to sanctions.  Providers as well as suppliers can bill state Medicaid programs for additional costs.  Although, states can limit Medicare cost sharing payments under certain conditions.

Unfortunately, even with this federal law in place, individuals who enroll in the QMB program may continue to receive unlawful bills.  Because many of the beneficiaries are not aware of this billing restriction, brokers/agents should explain the rules of dual eligible clients balance billing to their clients.  If a client is aware of his/her rights, they can avoid the stress of being unable to pay their bills or of receiving calls from a collection agency.