Providers are Prohibited from “Balance Billing” Patients Enrolled in the QMB Program

Members & Publications


February 11, 2016

The Qualified Medicare Beneficiary (QMB) Program is a state Medicaid benefit that covers Medicare deductibles, coinsurance, and copayments, subject to state payment limits (states may limit their liability to providers for Medicare deductibles, coinsurance, and copayments under certain circumstances).

Medicare providers may not balance bill QMB individuals for Medicare cost sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Further, all original Medicare and MA providers—not only those that accept Medicaid—must refrain from charging QMB individuals for Medicare cost sharing. Providers who inappropriately balance bill QMB individuals are subject to sanctions. For additional information, please see the revised Med Learn Matters Article.

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.