From the Field: New Medicare Patient ID System

Rick Collins

Sarah Tolson

Another major change is about to hit healthcare providers in 2018 that has the potential to cause reimbursement delays in Medicare and secondary payer reimbursement. In April 2018, the Centers for Medicare & Medicaid Services (CMS) will begin to replace all current Medicare patient identification numbers with a new numbering system.

The current patient identification methodology, the Health Insurance Claim Number (HICN), is based on the patient’s social security number. Railroad Medicare beneficiaries are assigned a similar number, known as the Railroad Retirement Number (RRN). The new Medicare identification number, the Medicare Beneficiary Identifier (MBI), will be distinct from the enrollee’s social security number and, in theory, all other identification numbers.

Since the renal industry’s patient population consists mostly of patients with Medicare as their primary payer, this dramatic change will have an especially big impact on renal providers. Thus, it is important for those of us in the renal industry to become informed regarding the implementation of the MBI. Begin preparing now so we can deal with possible reimbursement issues and assist patients who may be confused about the new numbers.

What are the time frames associated with MBI implementation?

The transition period for the implementation of the MBI will be 21 months, beginning April 1, 2018, and ending December 31, 2019. In April 2018, CMS will start mailing to beneficiaries new Medicare cards containing their MBI. Beginning that same month, Medicare will accept either the MBI or the HICN/RRN on all claims through December 2019. Additionally, beginning in October 2018, CMS will place the HICN/RRN and the MBI on every remittance advice. Effective with January 1, 2020, dates of service, Medicare will only accept the MBI.

What systems need to be updated to accommodate a new policy number format?

The current Medicare Health Insurance Claim number follows a format of nine numbers followed by an alpha suffix and sometimes an additional number in the eleventh position. The MBI will have 11 digits, some of which are specified as either alpha or numeric while other positions can be only alpha or numeric. CMS states that the MBI will be “non-intelligent” and “clearly different” from the HICN and RRN. For example, 1AE0WT8JR09 is a number that could be generated in the new format and is clearly distinguishable from the current system which always has numbers in the first nine slots.

Because the format of the MBI is significantly different from the HICN/RRN, you should reach out to your EHR vendor to see your software needs updating to accommodate the new Medicare ID number. Also, check with your electronic clearinghouse to ensure they will be able to accept the new number format beginning in April.

How will I know if my patients have received a new number if they don’t tell me?

Providers can determine if a patient has been assigned an MBI number by checking the patient’s Medicare eligibility. CMS states the information will be in the message field of the eligibility transaction responses. Of course, you should also inform patients they will be receiving a new Medicare identification card and regularly remind them to bring the card with them to the facility so the their new number can be recorded.

What can I do to help my patients through this transition?

Not all patients will realize they have received a new number, which they will need to provide to all of their healthcare providers and to their secondary insurance company. If you become aware of a patient’s MBI number before a patient informs you, notify the patient of their new number and encourage and/or help them to update their information with other providers and payers.

What education should I provide to my staff?

Inform all staff regarding the upcoming change and its accompanying timelines and milestones. Because patients could conceivably hand their new Medicare cards to any member of the staff, stress the importance of getting the new ID number to those who can update the patient’s insurance information. Staff members responsible for checking patient insurance eligibility should be trained to vigilantly watch for the message from CMS and/or the new ID number whenever they check eligibility.

Will my payments from secondary payers be affected?

While most large commercial payers will likely be ready to process the new MBI on secondary claims crossed over from Medicare, some smaller payers may not. You will want to have someone on your staff contact smaller payers to ask if they will be prepared to accept the MBI and, if not, how the payer will process secondary claims containing the new number.

Whether or not Medicaid systems will be updated in every state is always a mystery when major changes are implemented by Medicare. You will want to regularly check your state’s Medicaid website regarding the Social Security Number Removal Initiative (SSNRI) and their acceptance of the new MBI numbers. Medicaid agencies in some states currently include the Medicare HICN on the Medicaid ID card. CMS will be working with these states to either remove the HICN or replace it with the MBI.

Sarah Tolson is the director of training and Rick Collins is the chief operating officer for Sceptre Management Solutions, Inc., a company specializing in billing for outpatient ESRD facilities, nephrology practices, and vascular access. Your questions are welcome and they can be reached at 801.775.8010, stolson@sceptremanagement.com, rcollins@sceptremanagement.com, or via Sceptre’s website, www.sceptremanagement.com.