In October 2018, we will hit a milestone in the transition away from the use of the Social Security Number (SSN) as a Medicare beneficiary’s health insurance identification number. A reminder of the background behind this transition and what you can do to make sure it goes smoothly for your patients and your practice is certainly timely.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) - also known as H.R. 2 from the 114th Congress - includes the following in Section 501 - Prohibition of inclusion of Social Security account numbers on Medicare cards:
“The Secretary of Health and Human Services, in consultation with the Commissioner of Social Security, shall establish cost-effective procedures to ensure that a Social Security account number (or derivative thereof) is not displayed, coded, or embedded on the Medicare card issued to an individual who is entitled to benefits under part A of title XVIII or enrolled under part B of title XVIII and that any other identifier displayed on such card is not identifiable as a Social Security account number (or derivative thereof).”
The new Medicare Beneficiary Identifier (MBI) is distinct from the old SSN based Health Insurance Claim Number (HICN). The MBI is generated randomly so unlike the SSN, there is no intelligence or special meaning behind any of the characters. The MBI will include 11 alpha/numeric characters. The alpha characters will display as upper case on the card. The MBI will not include any special characters and to be sure that there are no questions about whether a character is a letter or a number, it will not include the letters S, L, O, I, B or Z.
Per MACRA, the process for issuing new Medicare cards must be updated to incorporate the new MBI by a date to be established by the Secretary of HHS but that date must be no later than four years after MACRA became effective. Likewise, replacement numbers/cards must be issued to patients currently enrolled in the program no later than four years after MACRA’s effective date. MACRA was signed into law on April 16, 2015.
The Centers for Medicare & Medicaid Services (CMS) established a timeline to meet these deadlines and CMS is on schedule. The key points are:
Educate Patients and Providers:
This step began in 2016 and is continuing – with increasing frequency and detail.
Issue New MBI:
Patients new to the Medicare program on/after April 1, 2018 receive only the new MBI. At this point in time, you should have identified and addressed any issues that prevent your business and system processes from using the new MBI since you have had to use it on claims for care provided to these new enrollees.
Patients already enrolled in Medicare will receive a new card in one of seven mailing waves. MACRA requires that this process be complete by April 16, 2019 (four years from passage of the bill).
||Status as of September 2018
|Patients New to Medicare
||DE, DC, MD, PA, VA, WV
|| AK, CA, HI, OR
||AR, IL, IN, IA, KS, MN, NE, ND, OK, SD, WI
||CT, ME, MA, NH, NJ, NY, RI, VT
||AL, FL, GA, NC, SC
||AZ, CO, ID, MT. NV, NM, TX, UT, WA, WY
||KY, LA, MI, MS, MO, OH, TN
Physicians and their practices will need to update their records replacing the HICN on file in the patient record with the new number. Obtaining that new number from the patient may be a more practical option for some specialties than others. As such, CMS offers other ways to access this information:
1. A secure portal on the website of the Medicare Administrative Contractor (MAC) that processes claims for your jurisdiction. The MBI will be available in this manner after completion of the mailing wave (see table above). To help protect this confidential information, some MACs may require you to log into their site per your enrolled provider status before allowing you to access the tool.
2. Remittance Advices (RA) you receive from the MAC with your Medicare payments.
This option pushes the MBI out to you. Make good use of this. Be sure that your billing staff/company are capturing this information and updating your practice’s records.
Transition to the new MBI
Unlike the transition to ICD-10-CM/PCS, there is no formal testing since either the old HICN or the new MBI can be used from April 2018 until December 31, 2019.
Starting January 1, 2020, only claims with the new MBI will be accepted.
|April 1, 2018 to December 31, 2019
|HICN or MBI
|January 1, 2020
There are reasons to make the switch as soon possible once patients in your state have received their new cards and you have access to the new number. The reason for the transition is to protect against identify fraud and the quicker the SSN is taken out of these healthcare transactions, the better for everyone involved!
For more information: https://www.cms.gov/Medicare/New-Medicare-Card/