Medicaid Mysteries: QMB Eligibility
Medicaid Mysteries: QMB Eligibility
Continuing Regional Eligibility Workshops June 2006
June 2006
1
Training Objectives
Increase participants knowledge of Medicare Savings Programs' (MSP) Coding and Eligibility requirements. These programs are known as QMB, SMB and SMF in Oregon.
Accomplish a quick review of the Medicare, Medicare Modernization Act (MMA), Buy-in, and the BEIN screen.
Provide participants with examples of case coding and Flow chart cheat sheets for future assistance
2
What Is Medicare?
A Federal Medical Entitlement Program Part A ? Hospital Part B ? Medical Part D ? Pharmacy ? new 1/1/2006
3
MIB CODE Medicare Insurance Benefit
Medicare Savings Programs
Qualified Medicare Beneficiary (QMB) - Pays for Part A & B Premiums, co-pays and deductibles
Specified Low-Income Medicare Beneficiary (SMB) - Pays for Part B Premium only
Qualified Individual (SMF) - Pays for Part B Premium only
MSP Case Descriptor must be coded on all cases with a MIB of 2 or 3.
5
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