QMB is a Medicaid program that assists low-income beneficiaries with Medicare premiums and cost sharing.
Effective Date: For claims processed on or after October 2, 2017
Summary of Changes: Creates an indicator of Qualified Medicare Beneficiary (QMB) status in the claims processing systems. Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims. The new claims processing systems QMB indicator will trigger notifications to providers (through the Provider Remittance Advice) and to beneficiaries (through their Medicare Summary Notice) to reflect that the beneficiary is a QMB individual and has no Medicare cost-sharing liability.
Three new Remittance Advice Remark Codes (RARC) were created 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, deductibleor co-payments.
- N782 – No coinsurance may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductibleor 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, deductibleor co-payments.
MACs will include a Claim Adjustment Reason Code of 209 (“Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA (Other Adjustment)).
Information obtained from: CMS MLN Matters Article: MM911 and CMS Change Request #: CR 9911