Deductible and Coinsurance Write-off Amounts for Qualified Medicare Beneficiaries (QMB)

On October 2, 2017 Medicare Administrative Contractors (MACs) began using Group Code OA (Other Adjustment) and Claim Adjustment Reason Code (CARC) 209 (“Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected.”) This informational CARC allows providers to identify a beneficiary enrolled in the Medicaid/Qualified Medicare Beneficiary (QMB) program and that the patient has no Medicare cost-sharing liability. CARC 209 indicates amounts identified may be billed to subsequent payers. Some providers’ accounting systems or software protocol may be automatically writing off these amounts. Providers will need to research their individual write-off procedures and software protocols. There is no issue with Medicare payments or application of copayments and deductible on these claims. Palmetto GBA is unable to assist providers with reconciling QMB patient accounts. Questions about Medicaid payments and write-off amounts must be directed to Medicaid.

Source: https://www.palmettogba.com/palmetto/providers.nsf/ls/JM Part B~ASBLVM8641?opendocument&utm_source=J11BL&utm_campaign=JMBLs&utm_medium=email