Is there ever a time when it is okay to bill copays to a QMB?ĬMS responded to our inquiry and we have added their responses to our Medicare Verification FAQs.What about statutorily excluded services-the things Medicare NEVER covers-are you able to bill those to a QMB patient?.Would you charge a QMB patient for maintenance care?.This modifier is defined via the Healthcare Common Procedure Coding System as identifying an Item or service statutorily excluded or Does not meet the definition of any Medicare benefit. We asked about billing for services that are considered medically unnecessary (such as maintenance care) and other procedures that are never covered by Medicare. If you are billing for a routine tetanus vaccination, it is recommended to append the GY modifier. In an effort to clarify what you can and cannot charge a QMB, we connected with CMS directly. View the following information below: Medical Necessity Non-Covered vs Statutorily Excluded Resources Medical Necessity. At KMC University we are aware of how hard you work for your reimbursements, and we never want you to leave money on the table. While you were implementing processes to avoid billing QMBs, KMC University researched ways to protect your reimbursements. In fact, some providers have created office policies that direct employees to NEVER bill QMBs for fear of violating Federal Law. It seems everyone is focused on not billing QMBs. The new QMB Indicators rolled out on July 1, 2018, and you probably have been busy implementing a process to identify the QMB status of your Medicare patients prior to billing.
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