CMS procedures change to accommodate new identification numbers

The new year brings opportunity, but also change. One such change is the use of Medicare Beneficiary Identifiers (MBI) — as of Jan. 1, all new Medicare transactions must use MBIs.

The reason for this change from Health Insurance Claim Numbers (HICN) to MBIs is that the Medicare Access and CHIP Reauthorization Act of 2015 required CMS to remove social security numbers (SSN), on which HICNs are based, from all Medicare cards by April 2019. MBIs, in contrast, are randomly generated. The MBIs are completely different from the old Medicare numbers and yet still include hyphens and spaces. CMS is clear to remind us in their Medicare Learning Network article that these hyphens and spaces are not to be entered on the claims electronically or on paper, as they are for illustration purposes only.

Here’s how this will affect our workflow:

ASK FOR THE CARD

It is important to gather the patient’s MBI at each visit as the beneficiary or authorized representative can request a change at any time. CMS can also change the MBI number if it feels the MBI number, which is considered personally identifiable information and is confidential, has been compromised.

CMS advises three possible ways to obtain our patients’ MBI numbers:

1. Ask our Medicare patients for their new cards; if they say they don’t have it, provide them with the flyer CMS has created (available at go.cms.gov/2R16n6y ) called “Get Your New Medicare Card.” (Note: It’s also available in Spanish.)
2. Use our Medicare Administrative Contractor secure lookup tool. (Find the relevant portal at go.cms.gov/37KUOr2 .) This tool does require us to have the beneficiary or primary wage earner’s SSN. If the patient will not provide the SSN, advise the patient to look up their own MBI number on mymedicare.gov .
3. Retrieve MBI numbers from remittance advice, obtained if we have seen a patient and received a payment decision generated since December 2018, that has included the beneficiary’s MBIs.

A few exceptions for use of the new MBIs exist:

1. Appeals will allow the use of either the prior HICNs or MBIs.
2. Claim status queries will allow the use of both the HICNs or MBIs, if the claim was for a date of service before Jan 1.
3. Span-date claims for 11X-Inpatient Hospital, 32X-Home Health and 41X-Religious Non-Medical Health Care Institution claims in which the start of care was before the transition period, or Dec. 31.

AVOID ERRORS

We must be certain to read over and print instructions from CMS for our billing team to reference, such as the above mentioned Medicare Learning Network article, which can be found at go.cms.gov/35C2avz .

If we are seeing rejection codes on our electronic claims, it could be the result of using an old HICN instead of the new MBI. Examples of these rejection codes would be Claims Status Category Code A7 (acknowledgement rejected for invalid information), 164 (entity’s contract/member number) and IL (subscriber).

Other interesting facts regarding MBIs include:

1. The MBI uses 0 to 9 numbers. The MBI does not include letters S, L, O, I, B and Z to avoid confusion with numbers.
2. Medicare Advantage plans, as well as prescription drug plans, will assign beneficiaries their own identifiers. CMS advises to continue to ask beneficiaries for and use their plans’ insurance cards.

LET’S BE DILIGENT

In an effort to protect patients’ identities, CMS has required the use of these new MBIs. Let’s take the time to educate our team of this, so we can be certain we are collecting the information and don’t have delays in patient care or billing. OM

DR. JASPER practices in West Palm Beach, Fla. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.