The explosive growth of identity theft, especially Medicare identity theft, has prompted important changes to patient Medicare information that will begin to affect Medicare providers starting April 2018.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, required CMS to remove Social Security Numbers (SSNs) from the Health Insurance Claim Number (HICN) on all Medicare cards by April 2019. Beginning in 2018, a new Medicare Beneficiary Identifier (MBI) will replace the SSN-based HICN for Medicare transactions like billing, eligibility status, and claim status. The new MBI number will be a new Non-Intelligent Unique Identifier of 11 bytes (e.g. 11 characters) and key positions 2, 5, 8, and 9 will always be alphabetic. For example, the new MBI would be structured like this: 1EG4-TE1-MK75. The most important reasoning as to why this is occurring is that removing the SSN off all Medicare cards will help to minimize medical identity theft for patients served by Medicare. The simple task of replacing the SSN segment on all Medicare cards enables better protection of a person’s private health data, personal health information and any information identifying a patients’ healthcare benefit and service payments that otherwise would be confidential.
Much like ICD-10, a “transition period” has been set up to help minimize disruption to patient encounters or billing. The transition details include the following:
- CMS established a transition period during which the HICN or MBI will be accepted from providers, beneficiaries, plans, and other external stakeholders
- CMS expects the transition period to run from April 2018 through December 31, 2019
- CMS’ processes and systems will be updated to accept and return the MBI as of April 1, 2018. CMS will accept, use for processing, and return to stakeholders either the MBI or the HICN during the transition period
- All stakeholders who submit or receive transactions containing the HICN must modify their processes and systems to submit or exchange the MBI as of April 1, 2019. Stakeholders may submit either the MBI or HICN during the transition period
Providers can to begin to prepare now for the transition. Specific steps include:
- Look at your practice management systems and business processes and determine what changes you need to make to use the new Medicare Beneficiary Identifier (MBI). You will need to make those changes and test them by April 2018, before we send out new Medicare cards.
- If you use vendors to bill Medicare, you should contact them to find out about their MBI practice management system changes.
For any client served by Medicare, this means nothing to their benefits, services or plan reimbursement. The new cards with the new schematic identifier will be sent to all Medicare recipients and can be used immediately upon arrival without any delay in services or activation steps. Being prepared for this transition will help to better serve your patients.
About the authors: As Senior VP at LumiraDx, USA, Helen is responsible for international collaborations. She was named by Health Data Management as one of “The Most Powerful Women in Healthcare IT ” 2016 and again in 2017. She was also a Health 2.0 “Ten Year Industry Leader” award recipient.
Jim St.Clair is a Director with Veratics, a service disabled veteran owned small business that specializes in agile adoption, health IT, and security and privacy. Mr. St. Clair’s business experience spans 23 years, including Senior Director of Interoperability at HIMSS.