Balance Billing of Medicare Covered Services is Prohibited

Spring 2018


Did you know that dual eligible patients are protected under federal law from liability for Medicare Part A and Medicare Part B deductibles and other cost-sharing charges? Under Section 1902(n)(3)(B) of the Social Security Act, as modified by Section 4717 of the Balanced Budget Act of 1997, providers who bill Qualified Medicare Beneficiaries (QMBs) for amounts above the Medicare and Medicaid payments are subject to sanctions (even when Medicaid pays nothing). This would apply to dual eligible members enrolled in Neighborhood’s INTEGRITY (Medicare-Medicaid Plan) and UNITY/Rhody Health Options.

For more information or questions regarding prohibition of balance billing, contact your Neighborhood Provider Representative or Member Services team.