Posted and filed under Compliance, Payers.

If you’re covered by Medicare, or if your patients are covered by it – you’re about to start feeling more of the effects of The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Most organizations have been preparing for MACRA’s ripple effects for years, so this wave of change may just be another to ride out. Either way, it’s important to understand the mandatory changes that are going into effect, and how they may affect you as a patient and/or provider.

New Medicare ID cards will begin being dispatched to patients this upcoming April, as a part of MACRA’s plan to remove all Social Security Numbers (SSNs) from Medicare cards by April 2019. Medicare patients will now be identified through a unique 11-character alpha numeric Medicare Beneficiary Identifier (MBI). MBIs will be randomly generated and “non-intelligent”, meaning that they will not have any hidden meanings. It is important to note that the new MBIs are different than a Medicare Beneficiary HIC number, despite each being comprised of 11 characters.

Your new MBI may look something like this: 1AB2-CE3-FG45.

New Medicare cards will be created and deployed in phases based off geographic location starting April 1, 2018. The reason for this change initiative is that MBIs will better protect the identities of Medicare holders. By replacing SSNs and HICNs, healthcare and financial information is better protected, along with patient data on federal healthcare benefits and service payments.

For providers and other partners of CMS, this shift from SSN-based identification to MBIs will require a period of transition. CMS has predicted that the transition period will last from April 2018 through December 31st, 2019. CMS will monitor the use of both HICNs and MBIs in order to determine the rate and readiness of full MBI adoption. Once this initial transition period is completed, CMS will require providers to submit claims using MBIs, regardless of when the services or procedures were performed.

Of course, there are a few exceptions to the rules for Medicare plans and Fee-for-Service claims. Among them:

Medicare Plan Exceptions:

  • Appeals
  • Adjustments
    • Reports

Fee-for-Service Claim Exceptions:

  • Appeals
  • Claim status queries
  • Span-date claims
  • Incoming premium payments

This means that big changes are afoot for providers, and it is integral to their operations that they understand the implications of these changes. Communication errors and other mistakes in claims submission can result in a dramatic decrease in reimbursement from Medicare.