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CMS reinstates change to Medicare Fee-For-Service claims processing system – 5 insights

CMS issued a notice to providers and suppliers stating that it will include Qualified Medicare Beneficiary information in the Medicare Remittance Advice and Medicare Summary Notice. Here are five things to know:

1. CMS began indicating QMB status and cost-sharing liability of patients on RAs and MSNs in 2017, but the program was suspended in December after unforeseen issues arose.

2. When the change was initially rolled out, state Medicaid agencies and secondary payers outside of the Coordination of Benefits Agreement process were unable to process QMB cost-sharing claims.

3. CMS resolved the technical issue and will begin implementing the QMB indicator on July 1, 2018.

4. In 2015, more than 7 million people were enrolled in the QMB program.

5. It is illegal for Medicare providers and suppliers to bill individuals enrolled in the QMB program for Medicare Part A and Part B cost-sharing.

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