Medicare Compliance & Reimbursement

Warning: CMS wants everyone on board by January 2020.

In a few weeks, CMS will begin mailing Medicare beneficiaries their new and improved cards. If you and your patients are shaky when it comes to the specifics, you're not alone. Read on and get ahead of the Medicare card transition.

Why: A combination of federal concern over rising issues with securing identity and Medicare benefit fraud prompted MACRA to outline a requirement for replacing the current style of Medicare cards. The refurbished cards ditch Social Security numbers (SSNs) as the primary identifiers. In place of the SSNs, which also work as the Health Insurance Claim Numbers (HICNs), CMS will distribute cards via mail with an entirely new 11-digit number called the Medicare Beneficiary Identifier (MBI).

"We're taking this step to protect our seniors from fraudulent use of Social Security numbers, which can lead to identity theft and illegal use of Medicare benefits," said Seema Verma, CMS Administrator, in a press release announcing the initiative.

Take a Look at the Distribution Timeline

MBI-inscribed cards are set to release in April 2018, according to CMS guidance. The agency "will begin mailing new Medicare cards to all people with Medicare on a flow basis by geographic location and other factors," noted the "New Medicare Card Mailing Strategy" report.

Between April and June 2018, the cards will be sent out in waves starting with Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia in the first group and ending with Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee, and the Virgin Islands in the 7th and final wave, the distribution report suggests.

Find out when your patients should look for the arrival of their new Medicare cards by state at: www.cms.gov/Medicare/New-Medicare-Card/NMC-Mailing-Strategy.pdf.

Critical: When the transition begins next month, providers must ensure their systems are MBI-ready and can perform "transactions, such as billing, claim status, eligibility status and interactions" in coordination with MAC contact centers, CMS says.

You'll also want to make sure your billing system is ready to do all of the following on day one, according to MBI guidance via CMS:

• Recognize and accept the new MBI.
• Revise your practice protocols for Medicare Railroad Retirement Board (RRB) patients because they won't be distinguished by their card numbers anymore.
• Accept automatically the new MBI from the Remittance Advice (835) transaction.

If you haven't already, alert your patients, software vendors, and business partners of the Medicare card and number overhaul, the agency advises. Patients' addresses must be accurate and verified by the start date to avoid delivery issues and delays. Moreover, it's of utmost importance that management prepare staff for new Medicare patients who will only receive a card with the MBI to avoid claims problems down the line, CMS suggests in its guidance.

Good news: "There will be a transition period when you can use either the HICN or the MBI to exchange data and information with us," notes CMS in its MBI fact sheet. "The transition period will start April 1, 2018, and run through December 31, 2019." The agency plans on monitoring Medicare provider efforts throughout this timeline, "so that Medicare operations aren't interrupted and that everyone is ready to use only MBIs by January 2020," states the CMS Open Door Forum (ODF) materials on the transition.

Plus: Patients may use their new cards as soon as they start receiving them in the mail, said Jean-Pierre Dalhouse, education outreach representative for Medicare Administrative Contractor (MAC) Noridian Healthcare Solutions in Fargo, North Dakota, in a recent webinar.

Know These MBI Fundamentals

Each unique MBI will consist of 11 randomly-generated alphanumeric characters that will be "non-intelligent." In other words, they won't have any special or hidden meaning, Dalhouse stressed.

CMS will use the numbers 0-9 and letters from A to Z in the MBIs, according to a CMS fact sheet. An exception to this rule is that the letters S, L, O, I, B, and Z will not be included.

If you're wondering what an MBI could look like, CMS offers this example for your reference: 1EG4-TE5-MK73.

Interesting: You may notice that although dashes do appear on the new cards, these dashes are not considered part of the MBI and should not be entered into computer systems or used in file formats, according to CMS advice.

Caution: Don't forget that the MBI is considered personally identifiable confidential information, just like a patient's HICN, so you should treat it as such. The protection of patients' privacy, safety, and security is what initiated the Medicare card revision in the first place. In fact, fraudsters are already intent on hacking into the new system. "Reports suggest scammers are simply retooling their efforts with more creative ways to extract personal financial information from victims, often times posing as a Medicare representative to do so," warned Ettinger Law Firm in its "New York Elder Law Attorney Blog" in analysis on the subject.

Resources: To utilize the CMS fact sheet on the new MBIs, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf.

To access various links and forms related to Medicare card changes, visit www.cms.gov/Medicare/New-Medicare-Card/index.html.