Federal law prohibits Medicare providers from collecting Medicare Part A and Medicare Part B cost-sharing (i.e., deductibles, coinsurance, or copayments) from those enrolled in the Qualified Medicare Beneficiaries (QMB) program. Unfortunately, in July 2015, the Centers for Medicare & Medicaid Services (CMS) released a study indicating inappropriate balance-billing still occurs despite the prohibition.

Therefore, we would like to remind you that when billing AmeriHealth for services rendered for these members, you must accept our reimbursement, according to your Agreement with AmeriHealth, as payment in full. For enrollees who are eligible for both Medicare and Medicaid, you may bill the State for applicable Medicare cost-sharing.

To learn more, read the Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the QMB Program article on CMS?s website.