Medicare Compliance & Reimbursement

Just because the feds recently issued Medicare Beneficiary Identifiers (MBIs) to beneficiaries doesn’t mean their MBI can’t change.

Beneficiaries or their authorized representatives can ask to change their MBIs for example, if the MBI is compromised, the Centers for Medicare & Medicaid Services (CMS) explains. Plus, the agency can also change an MBI.

Tip: “If you get an eligibility transaction error code (AAA 72) of ‘invalid member ID,’ your patient’s MBI may have changed,” CMS instructs providers. In that case, you can “do a historic eligibility search to get the termination date of the old MBI,” the agency advises.

If the dates of your claim span the new MBI effective date, you can use the old or new MBI on the claim, CMS adds.

Another tip: When you make an eligibility inquiry of the system with a new MBI, “we will return all eligibility data,” CMS details. If the inquiry uses the old MBI and the request date or date range overlap the active period for the old MBI, “we will return all eligibility data. We will also return the old MBI termination date.”

But you won’t get eligibility data if you use the old MBI and dates that are only after the new MBI’s effective date, CMS cautions. In that case, “we will return an error code (AAA 72) of ‘invalid member ID.’”

Update now: Don’t wait until Jan. 1 to start updating your patients’ charts with their new MBIs, CMS urges. Do it now, “before you are busy with other patient insurance changes in January,” the agency says.

HHAs: And home care providers may need to catch up, warns the National Association for Home Care & Hospice. While the overall MBI rate is 87 percent at last check, “performance by home health and hospice providers has lagged behind that of others,” NAHC warns in a recent message to members.

You can obtain your patients’ MBIs on their new Medicare cards, via your MAC’s MBI lookup tool, or on Remittance Advice, CMS advises.

Resource: More details, including advice on helping patients get their MBIs, is at  www.cms.gov/Medicare/New-Medicare-Card/index.