Get Ready for New Medicare ID Numbers

Kenneth J. Terry

Disclosures

November 30, 2016

In This Article

A New Wrinkle in How You'll Get Paid

As if there aren't enough changes taking place in medicine, here's another one that physicians and patients will be grappling with: The Centers for Medicare & Medicaid Services (CMS) is preparing to replace the current identification numbers of 60 million Medicare patients with new Medicare beneficiary identifiers (MBIs), starting in April 2018. This changeover, required by the Medicare Access and CHIP Reauthorization Act (MACRA), could increase claims denials as well as your staff's workload, experts warn.

Congress included this provision in MACRA because it was concerned that the current Medicare ID number, which includes the beneficiary's Social Security number, increased the potential for identity theft. To prevent this from happening, CMS will issue new Medicare cards that contain the MBI, an 11-digit alphanumeric code.

From April 2018 through the end of 2019, CMS will accept either the current number or the MBI on Medicare claims. Starting January 1, 2020, it will process only claims that bear the MBI.

Observers say that the transition to the new type of ID number could present a significant challenge to the industry. Here's what the issues are, and how you should prepare to deal with them.

Systems Will Need to Be Upgraded

Vendors will have a bit more than a year and a half to upgrade their systems to accept the MBI. Ron Sterling, a healthcare IT consultant based in Silver Spring, Maryland, doubts that this is enough time for the vendors to rewrite their applications, test them, and implement them with customers. "Don't underestimate the complexity of rolling it out," he says of the changeover.

Kathryn Austin, director of coding and data standards for the American Health Information Management Association, says that the major vendors will probably deal with the changeover on a timely basis. But the smaller technology companies may not move as fast, she points out.

"I'm not sure there will be enough time for the smaller practices and the smaller vendors, if they get onboard late, to test this in a timely manner," she says. "But because the transition period is over a year, all practices will be able to come onboard in that amount of time."

Practice billing applications may be part of an electronic health record (EHR) system or be included in a separate practice management system. If a medical practice has EHR and practice management systems from different vendors, notes Cindy Dunn, a consultant with the Medical Group Management Association, the suppliers will have to work together to upgrade the interface between the two systems.

Your practice's IT administrator should talk to your vendors about the MBI changeover in advance, Dunn advises. Consult with your billing service, too, if you use one.

So far, CMS has said nothing about testing the MBI. But Sterling notes that testing is essential, and that it should be end-to-end—in this case, between the practice and CMS—not just between the practice and the vendor. If the practice submits a claim with the old Medicare number and CMS sends back electronic remittance advice (ERA) with the MBI, he says, "A lot of practice management systems won't handle that very well."

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