Friday, September 29, 2023

SHIBA News Flash – Social Security scam & Qualified Medicare Beneficiary info

Warn clients of new Social Security scam

The Social Security Administration (SSA) reports scammers are impersonating it’s employees and calling citizens.

The caller claims the citizen is due a cost-of-living increase and they need to get some information so they can increase the citizen’s Social Security check.

SSA warns that if citizens give out their personal information to these scammers, they can edit their personal data and have his or her check sent to them.

If clients receive such a call, tell them to hang up and report it to the Inspector General at 1-800-269-0271. They can also submit an online complaint.

Starting this fall, Medicare providers & beneficiaries will receive notice of QMB status

If a patient has QMB, as part of the billing process, the Medicare contractor will notify Medicare providers

QMB (Qualified Medicare Beneficiary) is a Medicaid program that helps low-income clients with Medicare premiums and cost sharing. Federal law bars Medicare providers from billing someone with QMB for Medicare Part A and B deductibles, coinsurance or copayments.

To help Medicare fee-for-service providers understand when they cannot bill these patients for cost sharing, the Centers for Medicare & Medicaid Services (CMS) notified providers it will update the Medicare claims processing systems to identify the QMB status of each patient, effective Oct. 2, 2017.

Medicare clients will see a note on their Medicare Summary Notice (MSN)

Medicare clients with QMB who receive an MSN, will start to see a note in the “Maximum amount you may be billed” section that says:

“You’re in the Qualified Medicare Beneficiary (QMB) program, which pays your Medicare costs. Health care providers who accept Medicare can’t bill you for the Medicare costs for this item or service, but you may be charged a small Medicaid copay.”

Note that Washington state’s Medicaid program does not charge copays for these people.

As always, people with QMB, whether they have Original (fee-for-service) Medicare or are enrolled in a Medicare Advantage (MA) plan, should not be billed for copays for health services. They may still have a small copay for prescriptions drugs. SHIBA will continue to remind people with QMB to show both their Medicare or MA plan card and their Provider One (Medicaid) card to each provider before receiving medical services.

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