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Adjustments to Qualified Medicare Beneficiary Claims Processed Under CR 9911

On 10/2/2017, CMS issued CR 9911, which modified the Medicare RA for QMB claims to identify QMB patients and reflect zero cost-sharing liability. This change resulted in unanticipated issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the RA.

CMS has instructed MACs to initiate non-monetary mass adjustments for claims impacted by CR 9911 QMB RA changes. This includes claims that were paid after 10/2/2017 and up to 12/31/2017, and that have not been voided or replaced. The goal is to produce replacement Medicare RAs that providers can submit (when appropriate) to supplemental payers to coordinate benefits as necessary.

National Government Services is currently performing adjustments for QMB claims with dates of service prior to 12/7/2017 that received the QMB messages implemented on 10/2/2017. These adjustments have begun as of 9/6/2018 and are ongoing. Claims will be adjusted in the order in which they were initially received.

Providers will shortly receive a revised RA (and beneficiaries will receive a new MSN) as a result of any of your claims which are adjusted. No action is required on claims that secondary payers successfully processed through direct claims submission or the COBA process. Although mass-adjusted claims may not cross over, providers may use the new RAs to resubmit State Medicaid QMB cost-sharing claims that states initially failed to pay due to CR 9911 QMB RA changes. 

Providers should use these revised remittances to bill their state Medicaid Program or the beneficiaries supplemental insurer for outstanding deductible or coinsurance amounts if these amounts remain outstanding for this time period in 2017.

You do not need to contact the Provider Contact Center regarding these claims. NGS does not have information on payments made by other insurers or Medicaid.

As a reminder, the Special Edition MLN Matters® Article SE1128 Revised from CMS reminds all Medicare providers and suppliers, including pharmacies, that they may not bill beneficiaries enrolled in the QMB program for Medicare cost-sharing. Medicare beneficiaries enrolled in the QMB program have no legal obligation to pay Medicare Part A or Part B deductibles, coinsurance or copays for any Medicare-covered items and services.


Last Modified: 9/20/18

Adjustments to Qualified Medicare Beneficiary Claims Processed Under CR 9911

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