Is Your Urgent Care Clinic Ready for New Medicare Cards and MBI?

Due to requirements of the Medicare Access and CHIP Reauthorization Act of 2015, new Medicare cards will be mailed to the nearly 58 million beneficiaries starting in April of 2018. New cards will not include social security numbers (SSNs) in an effort to protect Medicare recipients against fraud and identity theft.

Replacing the SSN-based Health Insurance Claim Number (HICH) is a random 11-character alphanumeric code called the Medicare Beneficiary Identifier (MBI). This will be the number used for Medicare transactions like billing, eligibility status, and claim status. This new identifier will include only numbers and upper case letters (no special characters).

In an effort to be proactive, CMS recently issued a statement regarding the new cards. “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 CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”

What your urgent care staff needs to know.

1. New cards will be mailed out beginning in April of 2018 to all current beneficiaries.
2. Medicare benefits will not change.
3. Medicare cards for Railroad Retirement Board (RRB) Beneficiaries will include a logo—not a specific number.
4. During a transition period beginning no later than April 1, 2018, and running through December 31, 2019, beneficiaries and providers can use either the HICN or the MBI for claims, appeals, and related forms. After this time, CMS will require the MBI with few exceptions.

What your urgent care staff needs to do.

1. Recognize and begin to accept new cards as beneficiaries begin using them. According to the latest figures from the Department of Justice, the number of cases of identity theft of people 65 and older reached 2.6 million in 2014, up a half million incidents in just two years. Both providers and beneficiaries will be able to use secure look-up tools that will support quick access to MBIs when they need them.
2. Update your PM solution to be sure it can accept the MBI in place of the HICN. Update your practice management system’s patient numbers to automatically accept the new Medicare number from the remittance advice (835) transaction. Urgent cares using DocuTAP’s Insurance Card Validation should review their PM settings. Users can find this setting on the Ins Co Setup screen.To ease in the transition, beginning in October 2018 through the transition period CMS will return a patient’s MBI on every electronic remittance advice (ERA) for claims you submit with a valid and active HICN. It will be in the same place you currently get the “changed HICN”:  835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code).
3. Share information with patients. Your Medicare patients may be unsure about how this new card will affect their benefits. Be sure to let them know that their benefits will continue with no changes. Beneficiaries will be instructed by CMS to safely and securely destroy their current Medicare cards and keep the new MBI confidential.  Make patients aware that the card will be sent automatically. No one from CMS will contact them or ask for personal information regarding their Medicare card or benefits. Advise them not to share any of their personal or financial information with anyone posing as an agent of CMS.
4. Train staff. With all staff informed and on board, transitioning to the new card should be seamless. Be sure that before patients start showing up with new Medicare cards, your staff can identify the new card and is aware of any procedural changes you will be making in your clinic. If you use vendors to bill Medicare, contact them if they haven’t already shared their new Medicare card procedures with you.

Work on this important initiative to prevent fraud, combat identity theft, and safeguard taxpayer dollars began many years ago, and was accelerated following passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).