Preparing for the New Medicare
It is important that practices and their technology systems be prepared to accept Medicare Beneficiary Identifiers in April 2018 to ensure all claims are processed promptly and without issue.
Throughout the life of the Medicare program, practices have used beneficiaries’ Social Security number (SSN)-based Health Insurance Claim Numbers (HICNs) to process Medicare claims. However, due to growing concerns over Medicare beneficiary identify theft, Congress included a provision in the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) that mandates HICNs be removed from Medicare cards and replaced with an alternative identifier. This identifier replacement program was originally known as the Social Security Number Removal Initiative (SSNRI) but has since been renamed the New Medicare Card Program.
Under this program, Medicare beneficiaries will receive a new Medicare card containing a newly assigned patient identifier known as the Medicare Beneficiary Identifier (MBI). Although Medicare beneficiaries will still be assigned a HICN for use in other government programs, the MBI will replace the use of the HICN in Medicare administrative transactions, such as eligibility requests and claims. The Centers for Medicare and Medicaid Services (CMS) will begin mailing cards to the 60 million active Medicare beneficiaries in April 2018 and continue to do so on a rolling basis through April 2019. CMS has not revealed what regions or which groups of beneficiaries will receive their cards at what time to prevent criminal interception and fraud.
From April 1, 2018, through Dec. 31, 2019 (the “transition period”), CMS will accept either MBIs or HICNs on submitted claims. However, because beneficiaries new to the Medicare program will only receive a card with an MBI, it is important that practices and their technology systems be prepared to accept MBIs in April 2018 to ensure all claims are processed promptly and without issue. Beginning in January 2020, practices may only use MBIs in Medicare administrative transactions, with a few exceptions such as appeals and retrospective adjustments.
Preparing Practices for the Transition
In order to avoid any disruptions in care delivery and normal claims processing, practices that treat Medicare patients should discuss the New Medicare Card Program with their practice management and other health information technology vendors immediately to ensure each vendor is prepared to process MBIs on April 1, 2018. In particular, practices should ensure that their information technology vendors are prepared to:
- Update the practice’s system to automatically accept and store the MBI provided in the remittance advice transaction. Beginning in October 2018 through the end of the transition period, when a provider submits a claim using a patient’s valid and active HICN, CMS will return both the HICN and the MBI on the remittance. The MBI will appear in the “changed HICN” field.
- Prompt practice staff to ask a patient for the new Medicare card when an eligibility response includes a message indicating that CMS has mailed the beneficiary’s new card. Beginning in April 2018 and through the end of the transition period, when a practice submits a HICN on an electronic eligibility request for a patient who has been issued a new card, CMS will indicate on the eligibility response that the new Medicare card has been mailed.
- Save and store both the old HICN and the new MBI. While only the MBI will be accepted on Medicare transactions after the end of the transition period, practices may need the HICN for appeals, adjustments, or reporting functions.
- Program practice systems to identify patients who qualify for Medicare under the Railroad Retirement Board (RRB). RRB patients will not be distinguishable by the number on the new Medicare card; however, both the new Medicare cards and a message in the electronic eligibility response will flag RRB patients.
In addition to communicating with vendors, practices should also register to use the MBI look-up tool that will be available beginning in June 2018 through Medicare Administrative Contractors (MACs). Although providers must register with their regional MACs for look-up tool access, they will be able to search for any beneficiary’s MBI, regardless of where that beneficiary lives. All fee-for-service Medicare providers should have received a notice from CMS about the New Medicare Card Program and how to use their MAC’s secure portal to access the MBI look-up tool.
Preparing Patients for the Transition
Practices also play an important role in educating patients about the new Medicare cards and helping ensure this transition goes smoothly. Practices should request that their Medicare patients confirm their address is correct with the Social Security Administration to ensure beneficiaries receive their cards on time. Beneficiaries should also be reminded to bring their new cards to their next appointments in order to avoid any claims processing delays; this information can also be included in appointment reminders for Medicare patients. Note that CMS will not be sending a patient’s MBI in eligibility responses when the eligibility request used a HICN. Although the MAC look-up tool and the remittance advice transaction will provide MBIs, it is still critical that practices implement a system to remind beneficiaries to bring their new cards to appointments.
CMS has released flyers and handouts that practices can use to educate patients about the new Medicare cards and the importance of bringing the new cards to appointments. CMS is conducting wide-scale beneficiary outreach to help prepare beneficiaries for this transition; however, practices will play a critical role in reinforcing CMS’s messages.
Additional Practice Resources
Practices can access complete information about the New Medicare Card Program, as well as resources such as tear-off sheets and flyers, by visiting www.cms.gov/Medicare/New-Medicare-Card. The American Medical Association also offers resources to help practices prepare for the
New Medicare Card Program, which can be accessed at www.ama-assn.org/practice-management/prepare-new-medicare-card.
Finally, CMS recently appointed Dr. Eugene Freund as the provider ombudsman for the New Medicare Card Program. Practices with any questions or concerns about the program may contact Dr. Freund at NMCProviderQuestions@cms.hhs.gov.