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Last Modified: 6/27/2018 Location: FL, PR, USVI Business: Part A, Part B

Prohibition on balance billing qualified Medicare beneficiaries

Effective Date: N/A
Implementation Date: N/A


All Medicare physicians, providers, and suppliers who offer services and supplies to qualified Medicare beneficiaries (QMBs) may not bill QMBs for Medicare cost-sharing. This includes deductible, coinsurance, and copayments, known as “balance billing.” Section 1902(n)(3)(B) of the Social Security Act, as modified by Section 4714 of the Balanced Budget Act of 1997, prohibits Medicare providers from balance billing QMBs for Medicare cost sharing. QMBs have no legal obligation to make further payment to a provider or Medicare managed care plan for Part A or Part B cost sharing. Providers who inappropriately bill QMBs for Medicare cost-sharing are subject to sanctions.
Here is the link to the special edition MLN MattersŪ article SE1128 external pdf file.
Source: SE1128
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