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CMS QMB Remittance Advice Issue Alert

CMS QMB Remittance Advice Issue Alert

CMS has issued a “QMB Remittance Advice Issue” alert on Tuesday. CMS says that on December 8th, 2017, the system will revert back to the previous display of patient responsibility for QMBs on the Medicare RA. CMS suggests that you may want to hold QMB related claims and submit them after December 8th.  “In the interim for Medicare claims received between October 2nd and December 7th, 2017, and subsequently processed, you can identify Medicare cost-sharing amounts on the Medicare RA:

  • Group Code OA – Other Adjustment
  • Claim Adjustment Reason Code (CARC) 209-Per regulatory or other agreement
    • The provider cannot collect this amount from the patients.  However, this amount may be billed to subsequent payer.  Refund to patient if collected.  (Use only with Group code OA)
  •  The following Remittance Advice Remark Codes under Inpatient Adjudication Information (MIA) or Outpatient Adjudication Information (MOA):
    • N781 – Alert: No deductible may be co9llected as patient is a Medicaid/Qualified Medicare Beneficiary.  Review your records for any wrongfully collected deductible.
    • N782 – Alert: No coinsurance may be collected as patient is a Medicaid/qualified Medicare Beneficiary.  Review your records for any wrongfully collected coinsurance.

 

When billing Medicaid and other secondary insurers, RARC N781 equates to CARC 1 – Deductible Amount and RARC N782 equates to CARC 2 – Coinsurance Amount. If a claim contains both RARC N781 and N782, this means the beneficiary deductible and coinsurance amounts have been combined. To get a breakdown of these amounts, institutional providers can access the Direct Data Entry (DDE) system. CMS is in the process of identifying how professional providers can get a breakdown; CMS will share this information soon.”


For information on the Qualified Medicare Beneficiary (QMB) Program click here.

To view more information on the QMB Remittance Advice Issue click here.