APR 13, 2016
When to Bill Patients with Dual Eligibility Status
Questions arise regarding appropriateness of billing patients who are considered dual eligible–meaning they have both Medicare Part B and Medicaid benefits. The decision depends on the type of dual eligibility benefits the patient is entitled to. Billing patients who fall under the Qualified Medicare Beneficiary (QMB) assignment is prohibited. Practices should consider being paid in full from both Medicare and Medicaid. QMB status indicates the patients full Medicaid benefits assist in paying for Medicare’s premiums, deductibles, coinsurance and, if applicable, copays. Patients who are enrolled in the Specified Low-Income Medicare Beneficiary (SLMB) program and the Qualifying Individual (QI) program receive assistance in paying their Medicare Part B premiums. These patients may still have out-of-pocket expenses. Always follow the Remittance Advice (RA) from the payers as it will clearly state when and when a patient cannot be billed.
Additional information and resources on the CMS website.