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Get up to speed with Medicare’s MBI shift


Practices could face steep financial consequences from claim rejections if not adjusted.

stop medicare road sign

As of January 1st, 2020, healthcare providers are now required to submit Medicare claim transactions with Medical Beneficiary Identifiers (MBIs). CMS’ goal with the unique patient identifier, which replaces the old Medicare card and use of a social security number (SSN): to improve patient safety and security through the correct identification of individuals at the point of care. 

Has your practice completely switched over to MBI numbers?

If you answered “no,” “not yet,” or “not quite,” you’re not alone. Medicare issued an estimated 150 million MBIs to active and archived beneficiaries over the last two years. Yet as the American Medical Association (AMA) reported in November, 20 percent of Medicare physician claims are still being submitted with old patient identifiers.

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Practices that don’t get up to speed quickly could face steep financial consequences and a disruption in cashflow, stemming from a rise in claim rejections. Given what’s at stake, now is the time to embrace the new Medicare card, ensuring your patients, staff, and vendor partners can adjust to MBIs with ease. 


MBI Cards: Making the Switch

CMS’ move to MBI numbers has been in the works for a few years as a response to the risks and vulnerabilities associated with using an SSN, such as identity theft and data breach. The shift to MBIs is an effort to protect patient information and address past vulnerabilities when verifying patient identities.

According to one recent report, more than 1,200 data breaches occurred in 2018, and nearly 10 million records were exposed in the healthcare/medical realm. Moreover, the total number of data breaches in all industries more than doubled between 2017 and 2018. 

The new MBI is intended to protect patients and the healthcare providers who care for them from incidents of identity theft and breach, which can also lead to civil and financial penalties.

Yet with any administrative change, challenges or pitfalls are unavoidable. 

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First, providers face workflow challenges. Ensuring administrative staff is up to speed with the new rules is challenging enough, considering the sea of regulatory and administrative burdens that practices have faced in recent years. And in the shift toward value-based care, many practices have borne the onerous task of having to accommodate multiple risk-based, shared-savings plans overseen by multiple payer partners. 

Providers also face technology challenges. Specifically, if technology such as an EHR or practice management system is not up to date, or has not been upgraded to accommodate the new cards and patient identifiers, billers and coders will have a harder time doing their jobs-and managing the increased workloads that will naturally result from denied Medicare claims.


Getting Caught Up

For providers whose patients aren’t caught up, or who are experiencing issues with billing, coding, and/or reimbursement, here are a few best practices to consider:  

Communicate with your vendor partners. Ensure your partners, including your EHR vendor, RCM partners, or other outside experts such as consultants, are not only up to speed with the new identifiers, but are also processing claims in accordance with Medicare’s rules. Ask your vendor partners: Have they bolstered or upgraded their technology to process claims with the new identifier? And are they monitoring claim rejections? 

Go over changes and exemptions with staff. Administrative staff is likely aware of the shift to MBIs and ready to process claims using the new cards. They also know that if you submit with Health Insurance Claim Numbers (HICNs), Medicare will reject your claims. However, there are some notable exemptions, as detailed by CMS. Make sure staff is familiar with these.  

Boost patient education. The best way to ensure you can process claims using the MBI is to have your patients’ MBI information on file-so ask your Medicare patients for their Medicare cards when they come for care. If your patients don’t know their MBI, you can look it up via the Medicare Administrative Contractors (MACs) portal. If they don’t have their card, hand them the “Get Your New Medicare Card” flier in English or Spanish.  

Change is hard, and the shift to MBI numbers after years of using cards with social security numbers may be a bumpy one, especially if patients aren’t all caught up. But as with the transition to any new process or technology, the sooner you adapt to the changes, the easier it will be to run your practice.

Roland Therriault is President and Executive Vice President of Sales for InSync Healthcare Solutions. His experience in healthcare and technology includes more than 20 years of direct and channel sales, strategic planning and business development. Prior to joining InSync, Roland served as Vice President of Sales for MD On-Line, a provider of acute and ambulatory clinical and practice management solutions.

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