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New Medicare Cards Are Coming…Are You Ready?

August 25, 2017
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By: Lorraine S. Valle, Manager, Technology Consulting

Do You Have The Facts?

By April of 2019, Social Security Numbers (SSNs) must be removed from all Medicare cards, as stipulated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Replacing the SSN-based Health Insurance Claim Number (HICN) will be a new Medicare Beneficiary Identifier (MBI), which will be used for all Medicare transactions, including billing, eligibility status and claim status.

Medicare will begin mailing the new MBI cards to beneficiaries in April 2018 and the phased card issuance is expected to take a full year. It is important to note that beneficiaries who are new to Medicare after April 2018 will only be assigned an MBI. As this represents a significant change, there will be a transition period. During the transition period, expected to run from April 1, 2018 through December 31, 2019, providers may use HICNs or MBIs for all Medicare transactions. With limited exceptions, only MBIs will be accepted after January 1, 2020.

Why is This Being Done?

The change from HICNs to MBIs is primarily motivated by a desire to fight medical identity theft for Medicare beneficiaries. This change has been requested by Congress, the General Accountability Office, advocacy groups and people covered by Medicare for some time. The move is also an attempt to safeguard taxpayer dollars by combating fraud and illegal use.

The MBI will be unique and randomly generated and the 11 characters (made up of only numbers and uppercase letters) will not have any hidden or special meaning. Spouses or dependents, who may previously have had similar HICNs, will also receive new MBI cards. Patients who were previously hesitant to carry their SSN-based HICN cards or who blacked out portions of their Medicare cards due to fear of identity theft can comfortably carry the new MBI cards.

Are Your Policies Ready?

For providers that do not view patient insurance cards at each visit, it’s time to rethink your policies. Simply asking “is everything the same with your insurance” will not work.  Patients, who may not understand the implications of the HICN to MBI change, will often not present their new Medicare card, but simply state, “Yes, I still have Medicare.” Viewing the insurance card at each visit and updating the patient’s electronic record with the new MBI information once it arrives, is essential. While the transition period is long, any HICN-based claim sent after January 1, 2020 will be rejected.

Starting in October 2018 and continuing through the transition period, billing staff should be instructed to pay special attention to Medicare remittance advice.  Medicare remittance advice including claims sent using a patient’s valid and active HICN, will return both the HICN and the MBI. For patient records that were not updated at the time of the visit, this provides a wonderful second opportunity to update electronic patient records. The MBI will not be returned on eligibility requests sent with the HICN as this introduces an increased risk for medical identify theft, which the change to MBIs is specifically meant to address.

Railroad Retirement Board (RRB) Beneficiaries will no longer have a policy number that clearly indicates their RRB status.  Billing staff must pay special attention to the presence or absence of the RRB logo to ensure that claims are correctly routed.

Are Your Systems Ready?

Make sure that any system you use for billing (Electronic Health Records system, Practice Management system or Billing software) is ready to accept both the new MBI format and the legacy SSN-based format for beneficiaries who have not yet received their new cards. Some systems may currently require Medicare beneficiary policy numbers to be in current format and may reject the new MBIs. Contact your software provider to make sure that you are ready. If you utilize an outside billing service, make sure that they are ready for the change.

CMS is developing a secure look up tool to allow providers to access a beneficiary’s MBI without disrupting workflow if a Medicare beneficiary arrives at a provider’s office without the new card.  Confirm that your front office and billing staff will have access to the look up tool once it is launched. Additionally, the CMS HIPAA Eligibility Transaction System (HETS) will begin including a message in the response indicating that CMS mailed a new MBI card to that particular beneficiary.  It is important that current systems are able to accept and display this information.

For more information, visit
cms.gov/Medicare/SSNRI/Providers/Providers.html