Prohibition on balance billing
The Center for Medicaid and Medicare Services (CMS) prohibits balanced billing of Medicare recipients who are receiving Medicare Savings Program (MSP) benefits from the Qualified Medicare Beneficiary (QMB) program.
Balance billing is when providers and suppliers bill clients enrolled in the QMB program for Medicare Part A or Part B cost-sharing amounts.
Why is this important?
Improperly billing these clients violates the Medicare Provider Agreement. If you are a provider practicing balance billing, you may be subject to sanctions by CMS.
Who may be affected?
- Medicare providers
- Low-income Medicare beneficiaries
For more information see our balance billing prohibition fact sheet.
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