Anesthesia Coding Alert

Prepare now for the complete switch-over in 2020.

Another important step in shifting toward implementation of new Medicare beneficiary health insurance beneficiary numbers will happen in October, when Medicare remittance advices will include patients’ new identifiers.

Refresher: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) 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 completely different from the old SSN based Health Insurance Claim Number (HICN). The MBI is generated randomly so has no intelligence or special meaning behind any of the characters.

The MBI will be 11 characters in length and comprised of randomly generated numbers and uppercase letters, according to Jennifer Mangan, who works at National Government Services (NGS). It will not include any special characters or the letters S, L, O, I, B, or Z (to ensure that there are no questions about whether a character is a letter or a number).

Patients new to the Medicare program on/after April 1, 2018, receive only the new MBI. Multiple waves of mailings began in the spring of 2018 to send new cards to patients already enrolled in Medicare; the final mailing will take place in October. MACRA requires that all replacement cards be disseminated by April 16, 2019 (four years after passage of the bill).

What you do: Be sure to update your records to replace the HICN on file in the patient record with the new MBI number as patients come to your office. You can get this information from the patient, or through two other channels Medicare has established:

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. 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, so use them to cross-check your information.

Also important: There is no formal testing period for the new MBI cards since either the old HICN or the new MBI can be used from April 2018 until December 31, 2019. Beginning January 1, 2020, only claims with the new MBI will be accepted.

Good news: “I haven’t seen any issues with the shift,” says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. “One of the minor drawbacks I see is that I used to be able to spot a potential error in the patient’s number if it matched the patient’s Social Security number. I also used the letters to help with identifying information. However, I think it is much more import­ant to protect the patient’s Social Security number since hacking and stealing patient information is prevalent.”

Patients may use their new cards as soon as they start receiving them in the mail, says Jean-Pierre Dalhouse, education outreach representative for Medicare Administrative Contractor (MAC) Noridian Healthcare Solutions in Fargo, ND.