CMS reboots effort to curb illegal Medicare billing

The CMS is restarting an initiative meant to prevent providers from illegally billing some Medicare beneficiaries for cost-sharing.

The agency will start sending new billing notices to providers this summer, alerting them when certain beneficiaries should not be billed for cost-sharing, according to a Feb. 2 notice to clinicians.

The CMS first launched the effort last year after receiving reports that providers hit some patients that were dually eligible for Medicare and Medicaid with coinsurance costs even though they were enrolled in a savings program.

Under the Qualified Medicare Beneficiary program, which was enacted in 1988, Medicaid pays dual-eligibles' premium deductibles and coinsurance. The CMS estimates that more than 7 million people are in the QMB program.

But these patients can end up with debt collection for medical bills they weren't supposed to pay. In other cases, duals know they shouldn't be paying anything out of pocket but continued to do so because they're afraid of losing provider access, according to the CMS.

To stop this practice, the CMS announced last year that it would attach an alert on billing notices that would indicate a person is in the QMB program and thus has zero cost-sharing liability.

However, a few weeks later the agency said it was halting the effort after it heard that changing the notices created a technical issue in which claims for QMB beneficiaries were not paid by state Medicaid agencies and other payers secondary to Medicare such as Tricare.

The agency reverted to the previous display of the billing notices that did not contain QMB information.

The relaunch will start on July 1, according to the agency notice.

The CMS said it has made the technical and procedural changes necessary to ensure payments would by Medicaid and other payers for QMB enrollees.