Are you ready for the Medicare Beneficiary Identifier?

October 22, 2019 by Experian Health

It’s almost time to say goodbye to Health Insurance Claim Numbers (HICNS).

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) began the process of removing HICNs from Medicare cards, replacing them with a new Medicare Beneficiary Identifier (MBI). From January 1, 2020, CMS will only consider claims bearing the patient’s MBI number. With 150 million numbers issued to active and archived beneficiaries, the scale of the change could have a major impact on providers and their billing processes. Here, we look at how healthcare organizations can ensure they’re as prepared as possible.

Why change to a Medicare Beneficiary Identifier?

The shift to MBIs is an effort to protect patient information and address the vulnerabilities that come with relying on Social Security Numbers (SSN) to verify patient identities.

HICNs are tied to an individual’s (or their spouse’s) SSN, which, according to cybersecurity experts, is an increasingly lucrative route to stealing someone’s identity. In 2018, over 1200 data breaches were reported, with over 400 million records exposed. Of these, SSNs were the most commonly exposed piece of data across all industries, with the exception of the healthcare and medical sector (which is affected nevertheless, given the industry’s widespread use of SSNs). Once a fraudster has their hands on someone’s SSN, it’s all too easy for them to create a fake identity and wreak havoc on that person’s life.

What’s more, criminals can currently use SSNs in this way to access medical services or drugs under someone else’s name. Medical fraud is thought to cost between $80 and $230 billion annually in the U.S. If SSNs are no longer a means of confirming medical identities, the emotional and financial costs of medical fraud can be avoided.

So, while plans for funding a national patient identifier may have been stalled for now, the MBI represents a significant step forward to protect patients from identity theft, keeping their information safe and reduce the likelihood of medical fraud.

What does the transition to MBIs mean for your organization?

Like the implementation of ICD-10, this is a huge transition for CMS and providers alike. Most providers are already using both numbers to manage patient claims, with 76% of fee-for-service claims submitted using the MBI for the week ending July 5, 2019.

You can continue using the HICN for Medicare transactions such as billing, confirming eligibility status and checking claim status until the end of this year, but after that, Medicare will deny claims that don’t include the MBI. There are some exceptions, but the general rule is that claims must be submitted with the MBI, no matter when the service was provided.

How should providers prepare for the MBI transition?

The lower your denial rate, the healthier your revenue cycle will be. To avoid unnecessary denials as a result of the MBI transition, providers should consider the following strategies to ensure a smooth transition:

  1. Check systems and procedures

Your software systems, automated processes and patient-facing procedures should already have been adapted to accept MBIs. Ensure your staff have processes in place to check and add new MBIs for existing and current Medicare patients. Remember, you’ll need to continue tracking HICNs alongside the new MBIs for the lifecycle of current claims. Appeals will use whichever identifier was used to submit the original claim.

  1. Reach out to existing patients

The MBI won’t affect Medicare benefits, but recipients should all have received their new number and will need to use it to access services. Make sure existing patients are aware of the change and encourage members to update their details via their patient portal. Remind them to bring their new Medicare card to future appointments.

  1. Obtain an MBI for new patients

When new patients register with you, ask for the new MBI. If they don’t have it, you should be able to look it up using your Medicare Administrative Contractor’s (MAC) web portal. Train staff so they know what to ask, how to use the MBI and how to answer patients’ questions. Alternatively, for about the past year, when a claim has been submitted to Medicare with a HICN, Medicare has returned the MBI on the remittance (835 file). This is something that can be used to create crosswalks.

  1. Optimize for cleaner claims

One major effect of the change is that your existing method for carrying out Medicare scrubs, where SSNs could be used to check for Medicare eligibility based on demographic information, will no longer be possible. Consider a solution such as Claim Scrubber and Registration Quality Assurance to improve the accuracy of Medicare eligibility information.

  1. Encourage good data protection hygiene

This is a chance to review your data protection practices. Consider whether there are additional steps you could take to safeguard your patient data and prevent medical theft.

Are you ready?

Experian Health’s Coverage Discovery tool already contains many patient MBIs through its historical repository, which grows every day. This historical repository contains a dataset of MBIs, which will allow us to continue searching for and presenting Medicare coverage to our clients when the transition period ends.

Are you ready for this change to take place? Let’s schedule some time to review your coverage solutions and see if we can help improve your collection process.



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