Billing > Billing
MDCR / TMHP bathroom supplies
blhoffman:
No arguement from me. ;D I agree it is not a Medicaid plan. It does however pay more then just the patient's premiums for Medicare.
QMB (Qualified Medicare Beneficiary Program)
The QMB program provides the following benefits:
•Payment of Medicare Part A monthly premiums (when applicable).
•Payment of Medicare Part B monthly premiums and annual deductible.
•Payment of co-insurance and deductible amounts for services covered under both Medicare Parts A and B.
Pay_My_Claims:
there is a clause to that paying the deductibles. so in 99.9% of the cases. QMB won't pay. We get them all the time
blhoffman:
I was not aware of this clause so I did some research with CMS. I found this information on explaining all the rules and when what applies. Very interesting. I plan to keep a copy for myself, for future use.
Hope his helps.
http://www.cms.gov/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf
Pay_My_Claims,
I have appreciated all your advice and want you to know that I in no way want to be confrontational. In no way! I value your guidance. I know that these types of plans are very tricky and spent some time working with them. In the link above there is a section that I think is important for people to know. Learning is dynamic, there is something new to learn each day either because of invention, discovery or changes.
Balance Billing a QMB
For a QMB, Medicaid is responsible for deductible,
coinsurance, and copayment amounts for Medicare
Part A and B covered services. Providers may not bill
a QMB for either the balance of the Medicare rate
or the provider’s customary charges for Part A or B
services. The QMB is protected from liability for Part
A and B charges, even when the amounts the provider
receives from Medicare and Medicaid are less than the
Medicare rate or less than the provider’s customary
charges as specified in the Balanced Budget Act of
1997 (BBA). Providers who bill a QMB for amounts
above the Medicare and Medicaid payments (even
when Medicaid pays nothing) are subject to sanctions.
Providers may not accept QMB patients as “private
pay” in order to bill the patient directly and providers
must accept Medicare assignment for all Medicaid
patients, including a QMB.
blhoffman:
Pay_My_Claims
Sorry, I should have looked at the NC Health and Human Services. I found some information there and I see now what plan you were talking about earlier.
:o
Medicare-Aid
Medicare-Aid is a free Medicaid program for people who have Medicare and also have limited income and resources. The program can help pay your Medicare premiums, co-payments and deductibles. It is also known as Medicare Savings Program. There are three different levels of Medicare-Aid. All are based on an individual’s countable income.
Comprehensive Medicare-Aid (MQB-Q) covers:
1.Medicare Part B premium
2.Medicare Part A premiums (when applicable)
3.Medicare hospital deductible
4.Medicare annual deductible
5.20% Medicare co-payment
6.If you go into a nursing home, Medicare-Aid only covers the first 20 days. For more information, see Medicaid for long term care.
Limited Medicare-Aid (MQB-B) covers the Medicare Part B premium
Limited Medicare-Aid Capped Enrollment (MQB-E) also covers the Medicare Part B premium. Funds for this program may be limited.
Medicare-Aid Monthly Income Limits (Effective 04/2009) Program Number in Family
1 2
MQB-Q $903 $1,215
MQB-B $1,083 $1,457
MQB-E $1,219 $1,640
Pay_My_Claims:
--- Quote from: blhoffman on April 15, 2010, 03:55:26 PM ---I was not aware of this clause so I did some research with CMS. I found this information on explaining all the rules and when what applies. Very interesting. I plan to keep a copy for myself, for future use.
Hope his helps.
http://www.cms.gov/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf
Pay_My_Claims,
I have appreciated all your advice and want you to know that I in no way want to be confrontational. In no way! I value your guidance. I know that these types of plans are very tricky and spent some time working with them. In the link above there is a section that I think is important for people to know. Learning is dynamic, there is something new to learn each day either because of invention, discovery or changes.
Balance Billing a QMB
For a QMB, Medicaid is responsible for deductible,
coinsurance, and copayment amounts for Medicare
Part A and B covered services. Providers may not bill
a QMB for either the balance of the Medicare rate
or the provider’s customary charges for Part A or B
services. The QMB is protected from liability for Part
A and B charges, even when the amounts the provider
receives from Medicare and Medicaid are less than the
Medicare rate or less than the provider’s customary
charges as specified in the Balanced Budget Act of
1997 (BBA). Providers who bill a QMB for amounts
above the Medicare and Medicaid payments (even
when Medicaid pays nothing) are subject to sanctions.
Providers may not accept QMB patients as “private
pay” in order to bill the patient directly and providers
must accept Medicare assignment for all Medicaid
patients, including a QMB.
--- End quote ---
Hey BLK, I didn't know it was confrontational. I didn't take it that way at all. Its hard to determine "tone" in an email, but its all good!!
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