Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program
This new product comprises Subregulatory Guidance for the Prohibition of Billing Qualified Medicare Beneficiaries, and its content is based on publicly available content within the Social Security Act, Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), 1866(a)(1)(A), and 1848(g)(3)(A) at https://www.ssa.gov/OP_Home/ssact/title19/1902.htm,
42 CFR 455.410(d) at https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-455/subpart-E/section-455.410, 42 CFR 413.89 at https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-413/subpart-F/section-413.89, and the Provider Reimbursement Manual, part 1, chapter 3 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021929.
CMS policy or operation subject matter experts also reviewed/cleared this product. The fact sheet educates providers about billing requirements for Medicare beneficiaries in the Qualified Medicare Beneficiary eligibility group for Medicare Part A or Part B cost-sharing.
This product will be available to the public and posted on the CMS website at
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1128.pdf
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 31, 2024
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.