to be used for discharges occurring from October 1, 2018 through September 30, 2019 and for patient encounters occurring from October 1, 2018 through September 30, 2019. In a somewhat related story, on June 18th, the World Health Organization (WHO) released which is eventually expected to replace the ICD-10. If past is prologue, it will be several years before ICD-11 makes its way to American shores. CMS to Again Include QMB Status on Remittance Advice QMB status will be indicated in remittance advice. CMS previously included this information in remittance advice but had to stop to address unforeseen issues which have now been resolved. CMS is also introducing two new remark codes for QMB status. CMS informed the HBMA GR Committee about this change in our meeting at CMS. In an effort to improve the availability of information regarding Qualified Medicare Beneficiary (QMB) status, the Centers for Medicare and Medicaid Services (CMS) began indicating QMB status on remittance advice (RA) for Medicare claims on July 2nd. QMBs are dually eligible for Medicare and Medicaid. Providers are not allowed to bill QMBs for Medicare cost sharing including copays and deductibles. Providers can bill Medicaid for the cost sharing. CMS has been making a serious effort to reduce the improper QMB billing. CMS understands that most instances of improper QMB billing is due to a provider not knowing a beneficiary is a QMB rather than fraud. CMS has therefore been taking steps to improve the availability of this information. For example, CMS began including QMB status in HIPAA Eligibility Transaction System (HETS) 270/271 transactions. It also began including QMB status on RA in 2017 but had to suspend that function after a few months due to circumstances. “unforeseen” During the HBMA Government Relations (GR) annual visit to CMS headquarters Committee’s earlier this month, CMS informed the GR Committee that it would begin including QMB status in RA and in Medicare Summary Notices (MSN) in July.
to be used for discharges occurring from October 1, 2018 through September 30, 2019 and for patient encounters occurring from October 1, 2018 through September 30, 2019. In a somewhat related story, on June 18th, the World Health Organization (WHO) released which is eventually expected to replace the ICD-10. If past is prologue, it will be several years before ICD-11 makes its way to American shores. CMS to Again Include QMB Status on Remittance Advice QMB status will be indicated in remittance advice. CMS previously included this information in remittance advice but had to stop to address unforeseen issues which have now been resolved. CMS is also introducing two new remark codes for QMB status. CMS informed the HBMA GR Committee about this change in our meeting at CMS. In an effort to improve the availability of information regarding Qualified Medicare Beneficiary (QMB) status, the Centers for Medicare and Medicaid Services (CMS) began indicating QMB status on remittance advice (RA) for Medicare claims on July 2nd. QMBs are dually eligible for Medicare and Medicaid. Providers are not allowed to bill QMBs for Medicare cost sharing including copays and deductibles. Providers can bill Medicaid for the cost sharing. CMS has been making a serious effort to reduce the improper QMB billing. CMS understands that most instances of improper QMB billing is due to a provider not knowing a beneficiary is a QMB rather than fraud. CMS has therefore been taking steps to improve the availability of this information. For example, CMS began including QMB status in HIPAA Eligibility Transaction System (HETS) 270/271 transactions. It also began including QMB status on RA in 2017 but had to suspend that function after a few months due to “unforeseen” circumstances. During the HBMA Government Relations (GR) Committee’s annual visit to CMS headquarters earlier this month, CMS informed the GR Committee that it would begin including QMB status in RA and in Medicare Summary Notices (MSN) in July.
Washington-Report-June18.docx