Jan 10, 2020
 | 
The Bottom Line

Are you in compliance with Qualified Medicare Beneficiary (QMB) billing requirements? People with Medicare who are in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. Medicare providers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. Providers who inappropriately bill individuals enrolled in QMB are subject to sanctions.

Jan 10, 2020
 | 
The Bottom Line

Ideally the admission is coded as soon as possible upon admission, prior to entry of orders in the electronic medical record (EMR). This may not be a complete listing but should include diagnosis to support medications and treatments being provided to the resident.

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2019 Revenue Integrity Symposium

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