Please see below this important message from CMS regarding the new MSN and RA notices regarding QMB status.

 

Leslie

 

 

 

Hi all,

I wanted to update you on an issue identified with our systems changes to indicate zero cost-sharing for QMBs on provider Remittance Advices (RA).  It’s significant enough that we are temporarily suspending the systems change December 8, which means both the RA and the Medicare Summary Notices will revert to the “old” format.

As a refresher, on October 2, 2017, CMS modified the Fee-For-Service (FFS) systems to indicate the Qualified Medicare Beneficiary (QMB) status and zero cost-sharing liability of beneficiaries on the Medicare Summary Notice and Medicare Provider Remittance Advice. See Change Request 9911. These changes were part of our ongoing effort to promote compliance with the statutory prohibition on collecting Medicare A/B cost-sharing from the approximately 7 million QMBs.

However, the RA changes are causing unforeseen issues affecting the processing of QMB cost-sharing claims by states and other payers secondary to Medicare. More specifically, for providers who have to submit directly to state systems – a much higher incidence than we were aware – the change in where the cost-sharing liability appears on the RA is causing states and other payers to reject their claims. 

To address these unanticipated consequences in the short term, beginning December 8, 2017, CMS will temporarily suspend the system changes and revert back to the pre-October 2, 2017 versions of the Remittance Advice for QMBs. Unfortunately, the way the computer code was written, this also means suspending the changes to the beneficiary liability part Medicare Summary Notice. We are alerting providers and states this week (you can see the provider alert here). We are aggressively moving forward on how to remediate these issues, with the goal of rolling out fixes in summer 2018. 

The good news is that the change to the up-front HETS provider eligibility query is still on target for this month; it is unaffected by the above issue. Once live, it will indicate QMB status and zero cost-sharing liability. We’re excited by this because HETS is widely used by providers, suppliers and their authorized billing agents (including clearinghouses and third party vendors) to check the Medicare eligibility of their patients prior to submitting claims to Medicare. We’ll confirm the specific date just as soon as we hear.

We’ve really appreciated all you did earlier this fall to help publicize these changes. We now need to ask for your help in letting people know about the emergency action to suspend it, but that the HETS update will still be available soon.  If you have any questions, please let us know.

Thanks

Sharon