Medicare news: Treatment of dual-eligible patients

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Medicare news: Treatment of dual-eligible patients


Something to keep in mind: patients who are eligible for both Medicare and Medicaid and designated as Qualified Medicare Beneficiaries (QMB) cannot be billed for any Medicare cost-share, including deductibles, coinsurance and copayments. Federal law prohibits balance billing of these patients.

This applies to all Medicare providers regardless of whether they accept Medicaid.

The QMB program is a Medicaid program that exempts Medicare beneficiaries from having to pay their Medicare cost-share. If providers want to get paid for the patient's cost-share, the bill of service may be submitted to Medicaid for reimbursement.

For more information, please go to this Medicare Learning Network resource.