New Medicare Cards: Challenges and Opportunities

The main burden for this change is on healthcare providers such as physicians, clinics, hospitals.

The Centers for Medicare & Medicaid Services (CMS) will start issuing the new Medicare cards with the MBI (Medicare Beneficiary Identifier) number beginning April 1.  The Social Security Number (SSN) based HICN (Health Insurance Claim Number) is being replaced by an eleven-alphanumeric number.  The process of issuing the new cards should be completed by the end of 2019.  One of the main reasons touted for the issuance of the new cards is that of identity theft and increased security, the issuance of the new cards in and of itself generate certain risks.  Nonetheless, whatever can be done to protect SSNs should be implemented. 

The potential impact of these new cards will depend upon who you are.  We will look at the issuance of these new cards and the new MBI numbers from three different perspectives:

• Process
• Medicare Beneficiaries
• Healthcare Providers

In terms of process, the new card will start to be issued on or about April 1, 2018.  However, the issuance of the new cards will be in cycles spanning the better part of a year.  The old SSN number or HICN (Health Insurance Claim Number) will be recognized until the end of 2019.  Starting January 1, 2020 only the new MBI (Medicare Beneficiary Identification) number will be recognized.

The format for the new MBI number is eleven alphanumeric positions.  There are a number of restrictions as to what can be used and the order which the alphanumeric entries appear. Billing and claims filing software should already be undated to accommodate this change.  Check with your vendors to verify that the necessary changes have been implemented.

For Medicare beneficiaries, the question is whether or not they will even know that new cards are coming, and then, once they receive the new card, what action to take or not take.  Once the new card has been received, Medicare beneficiaries are directed to ‘destroy’ the old card.  This would mean micro-shredding or some equivalent (i.e., not just throwing into the garbage).

Note that some Medicare Advantage programs have their own cards, and these should continue in use as needed.  The concern is that with the elderly population that there will be confusion concerning the new cards.  For some, these new cards may be viewed a junk mail so that they will be destroyed upon receipt.  There is also concern that fraudulent activities will take place surrounding the issuance and receipt of the new cards.  Medicare beneficiaries need be well aware that they will not receive any phone calls relative to the new cards.

The bottom-line for Medicare beneficiaries is education and a full understanding that new cards are coming and what actions to take.

As seems usual, the main burden for this change is on the healthcare providers such as physicians, clinics, hospitals, and the like.  The overall goal is to have all patient records updated with the new MBI numbers.  The end of 2019 is the deadline for fully achieving this goal.

There are two main ways of obtaining the new MBI numbers:

1. Directly from the Medicare beneficiary,
2. Through a lookup function at your MAC (Medicare Administrative Contractor).

The most direct way is to ask the Medicare beneficiary when they come to the provider.  If they don’t yet have their new card, then this can be used as an educational opportunity to inform the Medicare beneficiary that they will be receiving a new card.  If they have their new card, then a copy can be made, and the provider’s system updated.  Given that this process will take more than a year, front desk procedures may need changing.  Depending upon timing and geographical dispersion of the new cards, there could be some operational impacts.  Anticipate that for a given geographical area that many cards will be sent and that registration personnel, for a given time period, may have to address almost every Medicare beneficiary that presents.

The second approach involves the use of a secure portal through your Medicare Administrative Contractor (MAC).  Starting in June 2018, this portal approach is planned to be available.  With a basic amount of information (e.g., name, HIC number, address, etc.) you should be able to look up the MBI number.  Of course, the number must have been assigned.  The way in which this process will (or will not) work is yet to be determined.  As with other lookup tools, anticipate challenges.

There are some less than obvious considerations.  One of these is cases that are in the appeals process.  Given the fact that the appeals process may take years, this change to the new MBI may not be reflected on a claim that is in the appeals process.  For Medicare Advantage plans, MAXIMUS^[1] has indicated that either the HIC or MBI number will be accepted.  For those provider personnel involved in the appeals processes, use care to make certain that this change does not affect the appeals process.

The bottom-line for providers is that the registration or front-desk activities may be increased.  Procedures may need altering.  Also, look for any less obvious impact such as with the appeals process.

^[1] See https://www.maximus.com/appeals/appeals-inquiries.

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