• Billing for Patients with Dual-Eligibility Status


    When patients have Medicare and Medicaid, or dual-eligibility status (PDF), they often receive some type of assistance with their Medicare premium payments based on income. Your remittance advice from payers will indicate when and if the patient owes anything out of pocket. 

    Be aware of these three program types:

    Specified Low-Income Medicare Beneficiary program

    • Patient receives assistance with Part B premiums
    • Patient may be responsible for deductibles and coinsurances

    Qualifying Individual program

    • Patient receives assistance with Part B premiums
    • Patient may be responsible for deductibles and coinsurances

    Qualified Medicare Beneficiary program

    • Patient receives assistance in paying for Medicare Part A and B premiums
    • Patient receives assistance for additional fees including deductibles and coinsurance
    • Physician must accept assignment for Part B services
    • Payment received by Medicare and/or Medicaid for services rendered are considered as payment in full
    • Patient cannot be charged even if services are provided in a different state
    • Physician cannot change the patient’s dual-eligible status.