Medical practices may see Medicare and Medicaid patients every day. What could be less common at your practice, however, is a patient who has both Medicaid and Medicare, known as a qualified Medicare beneficiary (QMB).
All Medicare providers—not just those that accept Medicaid—are prohibited from charging QMB patients for cost-sharing. If you’re in this category and you do balance-bill QMB patients, you could face fines and other sanctions.
The only way to ensure your practice stays on the right side of the law is to train your team properly from day one. Check out these five staff training tips to help you comply.
1. Create a Script for Gathering Insurance Information
The primary way to know up front whether a patient has both Medicare and Medicaid is to ask them, and then verify with the payers. This is not as easy as it sounds, since patients may not realize how important it is to tell you about both. Some patients don’t even realize there’s a difference between the two programs. So you should train your reception team to ask patients the specifics about each insurer when they make appointments.
To make this easy, create a script that the front desk can use when speaking to new patients. For instance, instead of advising them to say, “Who is your primary insurer?” to patients, perhaps they can say “How many health insurance cards do you have?” and once patients answer, ask them to read the numbers off each one no matter how long it takes.
Then the front desk team can contact each insurer and verify that information to find out if, in fact, the patient is a QMB.
2. Show Them How to Flag the Patient’s Status in Your System
Once you’ve confirmed that a patient is a qualified Medicare beneficiary, the team needs to record that information as accurately as possible within the system. Create a uniform way where staff members can flag that status in the system and train every team member to use it.
Here’s why it’s important: If one of your colleagues leaves a sticky note paper-clipped to the front of patients’ paper charts to denote QMB status, while another bolds the patient’s name in your scheduling system as a QMB signal, someone might miss this information and actually bill the patient cost-sharing, leading to potential violations at your practice. Ensuring that every team member denotes QMB status the same way will help you avoid issues.
3. Create a Go-To Contact List
When you’re creating your QMB training program, it’s important to have contact information for all of your key sources. This means finding phone numbers and email addresses for your payer reps and customer service teams at:
- Your local Medicare Administrative Contractor (MAC)
- Your state Medicaid office
- The state Medicaid offices of neighboring states
- The most popular Medicare Advantage plans among your patient population
Update the contact list frequently and always share it with the team every time you make a change. This contact list will allow your staff members to verify coverage and payer rules quickly and efficiently so you don’t make mistakes.
4. Remind Your Team to Treat All Patients Equally
Your staff should always treat your QMB patients as you would any other, so remind them of this during your training program. Patients with private insurance or Medicare alone should not get preferential treatment. When you create your staff training materials, impress upon each team member how important it is to give every patient the most positive patient experience possible.
5. Show Them How to Follow up on Payments
Once your staff members know how to identify QMB patients, the next step is to show them how to confirm that Medicare and Medicaid payers are reimbursing patients’ claims appropriately. Without the ability to charge the patient directly, you could lose money if you aren’t diligent about following up with these insurers about your reimbursement.
By training your team to stay on top of these issues, you’ll not only stay compliant with the QMB rules, but you’ll also ensure that you continue bringing in optimal reimbursement for your practice.
Your practice can’t afford to make an error when billing for dual-eligible patients—that’s why expert Owen Dahl, LFACHE, CHBC, LSSMBB, is here to help. During his online training, “Stop Costly Medicare/Medicaid Patient Billing Errors,” you’ll get real-world examples of how to stay on the right side of the law for QMB patients. Register today!
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