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

Question: Since early October I have noticed our practice has a considerable increase in the write-off amounts base on OA-209. Additionally, it does not appear as though deductible and copayments are being calculated correctly for some patients. Has something changed?

Answer: 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. 

Note: 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.

Full details are outlined in CMS MM9911 (PDF, 295 KB) and CMS SE1128 (PDF, 261 KB).

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