Qualified Medicare Beneficiaries, QMBs, cannot be charged for any Copayments or Deductibles. Who is a QMB? A patient who is eligible for both Medicare and Medicaid.
With the Coronavirus pandemic, many Medicare Beneficiaries have recently qualified for Medicaid. This applies whether the patient has regular or traditional Medicare, or if they have an Advantage or Medicare replacement plan. As Medicaid eligibility can change from month to month, at any time of the month, a Medicare patient may become dually eligible between visits.
New Medicare cards are being issued that replace social security numbers with MBI, Medicare Beneficiary Identifiers. See Medicare's alert on keeping these numbers private and secure.
By Mollie Frawley, R.N., FCA Help Desk Coordinator
Monday, 05 March 2018
Many
chiropractors in Florida have received a copy of a recent report from the
Office of Inspector General, U.S. Department of Health and Human
Services that calls for better controls to prevent fraud, waste and abuse
related to chiropractic services in Medicare.
This report is based on services between 2010 and 2014 and provides us
two important lessons.
The FCA has received confirmation from some members that they have received letters from FCSO requesting repayments on audited claims denied by Strategic Health Solutions (SHS). There has also been at least one notice of additional payments received on codes reported as under coded. There are no reports of the repayments including an extrapolation to all payments made in 2015.
This is VERY good news.
The positive is that there was no extrapolation. Most chiropractic physicians affected will be dealing with a couple thousand of dollars at most instead of tens or hundreds of thousands of dollars.
So what should those doctors who were audited do now?
Medicare is taking
steps to remove Social Security numbers from Medicare cards. CMS will start
mailing new cards to people with Medicare benefits in April 2018. All Medicare
cards will be replaced by April 2019.
Medicare is beginning the revalidation process again. If a practitioner or practice fails to respond timely to these requests they will be deactivated AND will not be able to bill Medicare or collect from the patient for services rendered while deactivated. Members are encouraged to alert their staff to look for any correspondence from Medicare or First Coast Service Options and respond urgently. Revalidations can be time consuming and frustrating. The financial impact could be significant, however, if not handled with urgency and importance. Continue reading for important links to help you revalidate with greater success.
First Coast Service Options, the Florida Medicare Contractor for Regular/Original Medicare claims, is encouraging providers that are currently receiving paper Remittance Advices (EOB's) to sign up for Electronic Remittance Advices. We are assured that this remains voluntary, but offers the benefits of electronic technology. Read further to learn more and view the notice from First Coast.
(From the ACA “Week In Review” of 06/27/2013) On June 17 , the National Uniform Claim Committee (NUCC) announced final approval of the Version 02/12 1500 Claim Form by the Office of Management and Budget. NUCC began revisions of the 1500 claim form in 2009 in order to accommodate reporting needs for ICD-10 and Version 5010.
