CMS has called on providers to solve problematic balance billing issues for patients enrolled in the qualified Medicare beneficiary (QMB) program, yet a key part of the puzzle -- identifying a patient's coinsurance deductible amounts -- appears to be plaguing certain payers.
In a Jan. 23 email, National Government Services (NGS) issued an update describing a technical error in CMS' newly unveiled QMB indicator program,
which went live in November. The QMB identifier tool, which is supposed to alert providers to a patients' QMB status and share current coinsurance and deductible amounts, is malfunctioning for certain segments of the QMB population, according to the NGS update.
That's a problem for providers because CMS has instructed all practices to submit QMB-related claims that they may have been holding onto pending the release of accurate copay and deductible amounts. When a practice mistakes those amounts, it may balance bill a patient -- and that could eventually
lead to Medicare sanctions, not to mention putting low-income patients in a bind.
The new QMB look-up tool is available through the CMS Enterprise Portal, which funnels the QMB status information to providers through the
HIPAA Eligibility Transaction System (HETS). The winding path providers must take to ascertain QMB status through the HETS portal appears to have hit a snag. Some patient data is not available, according to CMS.
For now, you should submit all QMB-related claims for which you can find accurate coinsurance and deductible amounts, notes NGS. For patients with missing figures, continue to hold your claims. Stay tuned to the Part B News blog for further updates on QMB billing status.