QMB Program - Qualified Medicare Beneficiary

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I'm getting a little confused regarding the QMB program and when/if you can
balance bill a Medicare patient for their deductible, co insurance etc.



Are all patients who have both Medicare and Medicaid considered a QMB?



If not .. how can I determine if a patient is a QMB?



As a non participating provider with our state Medicaid plan is it ever "OK"
to balance bill a patient who has Medicare as primary?



Cheryl Sarnowski, Administrator

c/o Marc Irwin Sharfman, MD PA

2137 West State Road 434

Longwood, FL 32779-4983

Phone: 407-644-3737 x 114

FAX: 407-644-3009

Email: Cheryl@headache-institute.com





This electronic mail/email message and any attachments may contain
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individual and purpose and is protected by law. If you are not the intended
recipient of this email, you are hereby notified that any disclosure,
copying, or distribution of this email and any attachments, or the taking of
any action based thereon, is strictly prohibited. If you have received this
email in error, please notify the sender by reply email or call 407-644-3737
x 114. Thank you.




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I’m =
getting a little confused regarding the QMB program and when/if you can =
balance bill a Medicare patient for their deductible, co insurance =
etc.

 

Are all patients who have both Medicare and Medicaid =
 considered a QMB?

 

If not .. =
how can I determine if a patient is a QMB?

 

As a non =
participating provider with our state Medicaid plan is it ever =
“OK” to balance bill a patient who has Medicare as =
primary?

 

Cheryl Sarnowski, =
Administrator

c/o Marc Irwin =
Sharfman, MD PA

2137 West State =
Road 434

Longwood, FL =
32779-4983

Phone: =
407-644-3737 x 114

FAX:  =
407-644-3009

Email: =
Cheryl@headache-institute.com

 

 

This =
electronic mail/email message and any attachments may contain =
confidential and/or private information intended solely for a specific =
individual and purpose and is protected by law.  If you are not the =
intended recipient of this email, you are hereby notified that any =
disclosure, copying, or distribution of this email and any attachments, =
or the taking of any action based thereon, is strictly prohibited.  =
If you have received this email in error, please notify the sender by =
reply email or call 407-644-3737 x 114.  Thank =
you.

 

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Comments

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    No all patients that have Medicare and Medicaid are not QMB. Some have SLMB
    which does not pay physicians. When I called our State Medicaid to check
    eligibility on a pt they could not even tell me if they had QMB or not.
    Some states you can check eligibility online and see it. Sometimes we just
    have to wait for the first claim and see how it processes. Maybe others
    have a better way to tell??? I know my ex husband was 40.00 above the
    income threshold for QMB and he has to pay his Medicare deductible and
    co-insurance.



    DIANA FRANKLIN, CMRS, CPC

    Member American Medical Billing Association

    Member American Academy of Professional Coders

    (931) 879-9854

    dianaf@twlakes.net



    Confidentiality Notice: Confidential Health Information Enclosed

    Protected Health Information (PHI) is personal and sensitive information
    related to a person's health care. It is being faxed to you after
    appropriate authorization from the patient or under circumstances that do
    not require patient authorization. You, the recipient, are obligated to
    maintain it in a safe, secure and confidential manner. Re-disclosure without
    additional patient consent or as permitted by law is prohibited.
    Unauthorized re-disclosure or failure to maintain confidentiality could
    subject you to penalties described in federal and state law.

    IMPORTANT WARNING: This message is intended for the use of the person or
    entity to which it is addressed and may contain information that is
    privileged and confidential, the disclosure of which is governed by
    applicable law.

    If you are not the intended recipient, or the employee or agent responsible
    to deliver it to the intended recipient, you are hereby notified that any
    disclosure, copying or distribution of this information is Strictly
    Prohibited. If you have received this message by error, please notify the
    sender immediately to arrange for return or destruction of these documents.





    From: Cheryl Sarnowski [mailto:cheryl@headache-institute.com]
    Sent: Tuesday, September 13, 2016 12:29 PM
    To: Multiple recipients of list PARTB-L
    Subject: [partb-l] QMB Program - Qualified Medicare Beneficiary



    I'm getting a little confused regarding the QMB program and when/if you can
    balance bill a Medicare patient for their deductible, co insurance etc.



    Are all patients who have both Medicare and Medicaid considered a QMB?



    If not .. how can I determine if a patient is a QMB?



    As a non participating provider with our state Medicaid plan is it ever "OK"
    to balance bill a patient who has Medicare as primary?



    Cheryl Sarnowski, Administrator

    c/o Marc Irwin Sharfman, MD PA

    2137 West State Road 434

    Longwood, FL 32779-4983

    Phone: 407-644-3737 x 114

    FAX: 407-644-3009

    Email: Cheryl@headache-institute.com





    This electronic mail/email message and any attachments may contain
    confidential and/or private information intended solely for a specific
    individual and purpose and is protected by law. If you are not the intended
    recipient of this email, you are hereby notified that any disclosure,
    copying, or distribution of this email and any attachments, or the taking of
    any action based thereon, is strictly prohibited. If you have received this
    email in error, please notify the sender by reply email or call 407-644-3737
    x 114. Thank you.










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    No all patients that have Medicare and Medicaid =
    are not QMB.  Some have SLMB which does not pay physicians.  =
    When I called our State Medicaid to check eligibility on a pt they could =
    not even tell me if they had QMB or not.  Some states you can check =
    eligibility online and see it.  Sometimes we just have to wait for =
    the first claim and see how it processes.  Maybe others have a =
    better way to tell???  I know my ex husband was 40.00 above the =
    income threshold for QMB and he has to pay his Medicare deductible and =
    co-insurance.

     

    DIANA =
    FRANKLIN, CMRS, CPC

    Member American Medical Billing =
    Association

    Member American Academy of =
    Professional Coders

    (931) =
    879-9854

    dianaf@twlakes.net

     

    Confidentiality Notice:  Confidential Health =
    Information Enclosed 

    Protected =
    Health Information (PHI) is personal and sensitive information related =
    to a person’s health care. It is being faxed to you after =
    appropriate authorization from the patient or under circumstances that =
    do not require patient authorization. You, the recipient, are obligated =
    to maintain it in a safe, secure and confidential manner. Re-disclosure =
    without additional patient consent or as permitted by law is prohibited. =
    Unauthorized re-disclosure or failure to maintain confidentiality could =
    subject you to penalties described in federal and state law.  =

    IMPORTANT =
    WARNING: This =
    message is intended for the use of the person or entity to which it is =
    addressed and may contain information that is privileged and =
    confidential, the disclosure of which is governed by applicable law. =

    If you =
    are not the intended recipient, or the employee or agent responsible to =
    deliver it to the intended recipient, you are hereby notified that any =
    disclosure, copying or distribution of this information is Strictly =
    Prohibited. If you have received this message by error, please =
    notify the sender immediately to arrange for return or destruction of =
    these documents.

     

    =

     

    From: Cheryl Sarnowski =
    [mailto:cheryl@headache-institute.com]
    Sent: Tuesday, =
    September 13, 2016 12:29 PM
    To: Multiple recipients of list =
    PARTB-L <partb-l@list.partbnews.com>
    Subject: [partb-l] =
    QMB Program - Qualified Medicare =
    Beneficiary

     

    I’m =
    getting a little confused regarding the QMB program and when/if you can =
    balance bill a Medicare patient for their deductible, co insurance =
    etc.

     

    Are all patients who have both Medicare and Medicaid =
     considered a QMB?

     

    If not .. =
    how can I determine if a patient is a QMB?

     

    As a non =
    participating provider with our state Medicaid plan is it ever =
    “OK” to balance bill a patient who has Medicare as =
    primary?

     

    Cheryl Sarnowski, =
    Administrator

    c/o Marc Irwin =
    Sharfman, MD PA

    2137 West State =
    Road 434

    Longwood, FL =
    32779-4983

    Phone: 407-644-3737 =
    x 114

    FAX:  =
    407-644-3009

    Email: Cheryl@headache-institute.c=
    om

     

     

    This =
    electronic mail/email message and any attachments may contain =
    confidential and/or private information intended solely for a specific =
    individual and purpose and is protected by law.  If you are not the =
    intended recipient of this email, you are hereby notified that any =
    disclosure, copying, or distribution of this email and any attachments, =
    or the taking of any action based thereon, is strictly prohibited.  =
    If you have received this email in error, please notify the sender by =
    reply email or call 407-644-3737 x 114.  Thank =
    you.

     

     

     

     

     * =
    * *Part B-L is sponsored by Part B News (www.partbnews.com), which is =
    published by DecisionHealth (http://www.decisionhealth.com)=
    . Call us toll-free =
    877-602-3835 To =
    unsubscribe: Go to http://www.decisionhealth.=
    com/partb-l
    ; Type in your email address; Click “My =
    Forums”; Click =
    “unsubscribe” Going on vacation? Set your membership to no email. Here’s how: =
    http://www.decisionhealth.=
    com/partb-l
    ; Type in your email address; Click “my =
    account”; Look for “Membership type” and click the =
    arrow next to the box; Select no email; Click “save =
    changes”; Click “log =
    out.” If you =
    belong to more than one of our forums, simply click on one of the forums =
    and follow the same directions as above. The selection you make, e.g., =
    “no email,” should apply to all of your =
    forums. To post to this =
    list, use partb-l@list.partbnews.com=

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