The unique demands of QMB patients – Ophthalmology Management

Certain patients are in a special category known as “Qualified Medicare Beneficiary” (QMB) that affects how you treat them financially.  Here are the considerations you need to address in your practice.

This article addresses the following questions:

  • What is a Qualified Medicare Beneficiary?
  • Why is it important to properly identify these patients?
  • If we are not a participating provider with Medicare, are we still subject to QMB?
  • Are we still subject to QMB limitations if we are not Medicaid providers?
  • What if Medicaid does not pay, even if we are enrolled providers?
  • If the patient we are seeing is from out-of-state, does QMB still apply to us?
  • Suppose the patient wants to pay us outside of any insurance; can we do that?
  • How do we identify these QMB patients?
  • Does Medicare offer any other advice?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:;-reimbursement

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