QMB 2018 Billing Rule: Avoid Massive Claim Denials

Length: 60 minutes Expert: Jennifer Searfoss, Esq.

Medicare recently modified how you identify and bill for patients that are enrolled in the Qualified Medicare Beneficiary (QMB) Program.

ALL fee-for-service Medicare providers and suppliers, regardless of their specialty, will be affected by this change. In 2016, 7.5 million individuals (more than one out of eight Medicare beneficiaries) were enrolled in the QMB program. Accordingly, lack of compliance with these new rules will result in denials and reduction in your Medicare revenue. However, with some help you can comply with these new requirements.

Healthcare attorney and coding instructor, Jennifer Searfoss, Esq, CPOM, CHCI, CMCS presented an online training session, QMB 2018 Requirements: Comply with New Medicare Rules. During this training, Jennifer will provide you with plain-English advice on how you can comply with the recent QMB changes.

Here are just a few of the QMB questions you’ll be able to answer after viewing this practical, step-by-step, 60-minute online training:

  • Master billing requirements for beneficiaries enrolled in Medicare Advantage
  • Successfully collect Part D copayments from QMB-qualified patients
  • Get paid for Medicare cost-sharing for QMBs from state Medicaid programs
  • More quickly identify your patient’s QMB status before submitting claims
  • Correctly utilize the Medicare Summary Notice to identify QMB patients
  • Identify Medicare patients that you are unable to balance bill copays
  • Determine whether registering as a HETS user will help your QMB reimbursement
  • Identify what billing limits apply when issuing an Advanced Beneficiary Notice
  • Pin down when you can bill a dual eligible beneficiary for statutorily excluded Medicare services
  • Effectively decipher the revised QMB-specific Alert Remittance Advice Remark Codes (RARC)
  • Proven resources to define CARCs, RARCs, claim status, and claim status category codes
  • Better understand what the most common Medicare remittance codes mean and what to do about them
  • Utilize essential tools for eligibility verification before claims leave your office
  • And so much more…

If you get a handle on these new QMB regulations, you don’t have to stress over high Accounts Receivables due to low first-pass claims payments. You can pin down a patient’s QMB status before you submit your claim and avoid the denials altogether. By investing just 60 minutes of your time, you can accomplish this and so much more.

Don’t risk complying with these complex QMB Program requirements on your own. Order this expert-led online training and get the advice you need to get paid more accurately the first time.

Meet Your Expert

Jennifer Searfoss
Esq.Chief Legal and Compliance Officer

As the Chief Legal and Compliance Officer for U.S. Foot and Ankle Specialists, Jennifer Searfoss, Esq. leads and manages the legal and compliance functions for the MidAtlantic group.

Jennifer has always been passionate about helping physicians improve their compliance. As the Founder and CEO of the Searfoss Consulting Group (SCG Health), she focused on improving providers quality measurements. Prior to taking on the role as entrepreneur, Jennifer was the Vice President of External Provider Relations for UnitedHealthcare where she reviewed and approved education programs for commercial and Medicare physicians.

Her background in legal and compliance began with the accomplished foundation of serving the Medical Group Management Association (MGMA) as the External Relations Liaison. In addition to coordinating MGMA advocacy, she also was the Government Affairs Representative for the Eastern & Southern Sections.

Jennifer has had the pleasure of teaching health care law at the University of Maryland, Baltimore County and health care policy at George Washington University. She received her undergraduate degree in health science and policy from the University of Maryland, Baltimore County and law degree from the University of Maryland. She is a member in good standing of the Maryland bar since 2005. Jennifer, her husband and their two fuzzy children (a cat and a dog) reside in Northern Virginia.