Changes to the Medicare ID Format Now Required

Sign that says: 2020 Medicare Requirement Are You Ready

What You Need to Know

Previous changes to the Medicare ID format will be required beginning January 1st, 2020.  These requirements will affect physical therapists that submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.  In this article, we’ll discuss these requirements and what you need to be aware of.

First, Why the Change?

Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), The Centers for Medicare & Medicaid Services (CMS) were required to remove social security numbers from all Medicare cards by April of 2019.  CMS replaced the Health Insurance Claim Numbers (HICN) with the new Medicare Beneficiary Identifier (MBI).

The new cards offer better identity protection because they no longer have the patient’s social security numbers printed on the cards.  With the increase of identity theft, this is a change that will benefit patients.

Required Action

Starting now, even if you are reading this before January 1st, 2020, you should use the MBI for all Medicare transactions.  CMS have already mailed the new Medicare cards, so MBIs are now in effect.

With just a few exceptions, Medicare will reject claims submitted with HICNs, so using the MBIs is critical to getting reimbursed.

How to Get MBIs

  1. The easiest way is to ask your Medicare patients for their new Medicare cards when they come into the office.  If, by chance, they haven’t received their new cards, please give them the “Get Your New Medicare Card” flyer.  These flyers are available in English and Spanish.

  2. If your Medicare patient doesn’t bring in their card, you can look it up through the Medicare Portal.  You can look up your state’s Medicare Administrative Contractors (MACs) Provider Portal here.  You will need your patient’s social security to search for the MBI, and it may differ from the HICN, which uses the social security number of the primary wage earner.
    NOTE: If your patient does not want to give you their social security number, the patient can log into mymedicare.gov to get their MBI.
  3. Medicare will also return the MBI on every remittance advice when you submit claims with valid and active HICNs through December 31st, 2019.  We recommend that you get the MBI from the remittance advice and save it to use for future Medicare transactions.

Using the New MBI

The MBI will go in the same field where you’ve previously placed the HICN, and this applies to reporting informational only and no-pay claims.  The MBI also replaces the HICN on Medicare transactions including Billing, Eligibility Status as well as Claim Status.

Things to Be Aware of

Like the HICN, do not use hyphens or spaces when using the MBI.  The MBI uses numbers 0-9 and all uppercase letters except for “S”, “L”, “O”, “I”, “B” and “Z”.  These are excluded to avoid misinterpreting those letters with some numbers, like “0” and “O” or “1” and “I”.

MBIs are here.  If you are not using MBIs yet, it’s definitely time to start.  Of course, there will always be a few exceptions to the rule, and that’s where StrataPT can help.  With our system’s built-in validation tool, you can be sure that there are no database entry errors before submitting, so there’s no downtime with denials or re-submissions.

If you have any other questions about MBIs, please don’t hesitate to contact us.  Our knowledgeable staff can answer your questions and show you how StrataPT can provide your practice, no matter how small or large, with a level of billing transparency, operational insight and customer support that far exceeds any other billing company in the industry.  To request a demo, please click here.

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