Home Health & Hospice Week

You may not want to pull the trigger quite yet.

Now that your patients are getting their Medicare Beneficiary Identifier numbers, should you start using them on claims?

Reminder: The Centers for Medicare & Medicaid Services started sending out new Medicare cards with MBIs last month. "MBIs will replace the existing Social Security Number-based Health Insurance Claim Number (HICN) on the new Medicare cards and in the systems Medicare uses now," CMS explains in a recent update. "Medicare will replace all current cards and SSN-based numbers by April 2019."

CMS urges providers to "use the MBI to bill Medicare as soon as you get a Medicare patient's new number" and to "use the transition period to make sure your systems can accept and transmit MBIs."

But providers may want to hold up a minute. On May 7 and May 8, HHH Medicare Administrative Contractor CGS reported two claims processing problems related to MBIs.

Problem #1: For claims submitted with the new MBI, "the Fiscal Intermediary Standard System (FISS) is attaching an invalid [HICN] to the claim, causing the claim to go to the Return to Provider (RTP) file for various reasons," according to CGS's claims processing issues website.

Problem #2: And claims originally submitted with an HICN "are being incorrectly displayed in Direct Data Entry (DDE)" with the MBI, CGS says. "Claims should be displaying in DDE with the original identifier submitted on the claim (either the HICN or MBI)."

Solution #1: Research for this problem is underway, but in the meantime providers can "suppress the claim showing in the Return to Provider (RTP) file with the invalid HICN and resubmit the claim using the beneficiary's correct HICN," CGS advises.

Solution #2: "If you use the MBI returned through this display error on claims, the beneficiary will receive a Medicare Summary Notice with the MBI on it, possibly before they receive their new Medicare card containing their MBI," CGS says.

"This issue will be resolved no later than May 29, 2018." Until then, do not use a beneficiary's MBI until either they present their new Medicare card with the new MBI on it; the MBI is available through your MAC's secure portal; and/or their MBI is shared through the remittance advice starting in October 2018.

One hospice caller in the May 15 Open Door Forum for home health and hospice providers reported an additional problem. When the hospice tested April claims with MBIs, they processed correctly for patients who didn't have prior claims, the hospice rep reported. But for patients that did have prior claims, the claims rejected.

More information on the problems is at www.cgsmedicare.com/hhh/claims/fiss_claims_processing_issues.html.