Coach Jo-Anne: Q: “Medicare has made some major changes in the new Medicare card in 2018. Let’s go over what you need to know.”
A: Medicare has made some major changes in the new Medicare card in 2018. Let’s go over what you need to know. This is a brief overview; I strongly recommend that you go to the CMS.gov website to really learn about it. Why is the card changing? The most important reason it’s changing is its fighting medical identity theft for people in Medicare.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal of Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status and claim status. So, it really comes down to identity theft, and I was wondering when they were going to come around to doing it since everybody else has been doing it.
CMS currently uses a SSN-based Health Insurance Claim Number (HICN) to identify people with Medicare and administer the program. They have used the HICN with their business partners’ social security administration (SSA), the United States Railroad Retirement Board (RRB), State Medicaid Agencies, health care providers and health plans.
Under the new system, for each person enrolled in Medicare, CMS will: assign a new Medicare Beneficiary Identifier (MBI), they will be mailing a new Medicare card, and the MBI is confidential like the SSN should be protected as Personally Identifiable Information.
Now, when you look at your current Medicare card, you’ll see the Primary Beneficiary Account Holder Social Security Number (SSN) plus the Beneficiary Identification Code (BIC), so basically it’s the social security number with a letter after it. The key positions is 1-9 are numeric, and then you have one letter or a letter and a number, and so forth.The example here would be the 123-45-6789-A – Primary Beneficiary HICN. Let’s say that you’re a spouse who didn’t work, you would use your husband’s social security number, 123-45-6789-B to identify. If you were working and you would have your own number, but there are so many letters, it could be like for dependence and for disabled or just multiple letters at the end. But the new MBI has new non-intelligent unique identifier, 11 bytes.
Coach Laureen: [Laughs] Wait, our government having something non-intelligent? Sorry, I couldn’t help myself.
Coach Jo-Anne: But the key positions are 2, 5, 8 and 9 will always be alphabetic. So, if you look down at this example, we look at the way our social security number is now and it’s like the 123-45-6789. In this case, it’s A1. Then, the new MBI, 1E is the second position and then this 1EG4 is just very different looking; very, very different looking. This identifiers are fictitious and dashes for display purposes only, they are not stored in the database nor used in file formats. But that’s the difference.
It’s going to be so hard to really… I’m so spoiled having the social security number. It’s going to be hard because a lot of times you don’t get good information from the front desk, so you always had the Medicare number. If it ended in an A, you know that was the social and so forth. But there is a very definite timeline, January 2018 will be activating the MBI Generator & Translation Services. Then, from April 1, 2018 through December 31, 2019 we will transition. During this transitional period you can use either the old number or the new number. January 2020, only the MBIs on claims will be accepted with few exceptions.
Coach Laureen: That’s a long transition period.
Coach Jo-Anne: I’m grateful because I can just imagine. This is a visual timeline that Alicia presented where it just shows you the January 18th and then the block of time where they’ll accept both the HICN and the MBI and then the January 2020 where you can no longer use it except for some limited exceptions and I’ve listed those.
Medicare Plan Exceptions – The first bunch of exceptions is Medicare Plan Exceptions and that would have to do with appeals where you can use either the HICN or the MBI for claims appeals and related forms, which make sense because if you’re appealing something during a time period where you use the old number, obviously you’re going to have… you can switch it out, you have to appeal the claim with the old number. Or any adjustments, you can use the HICN indefinitely for some systems such as drug data processing, risk adjustment processing, and encounter data, and for all records not just adjustments.
Then, for some reports, I’ll use the HICN on these reports until further notice. It’s incoming to Medicare, quality reporting, disproportionate share hospital data requests, and so forth. Then, outgoing from Medicare: Provider Statistical & Reimbursement Report, Accountable Care Organization reports, etc. So, it’s going to be a slow process before we’re really there.
I only cited a couple examples for the fee for service. There are a couple more, one is appeals where again, you can either use the HICN or the MBI for the claims appeals and the related forms. So if you get a denial for something, December 2019, in January 2020 you obviously have to use the old number in 2020.
The same with claim status query, if you are looking up something that was done during the time period and used the old number, that’s an exception as well, you have to use that old number to query, see if the claim is pending or paid and so forth.
There are ways that you can learn more. You can participate in the open door forums, which is all advertised through CMS and they are presented by CMS and they will be letting you know when the calls are scheduled in MLN Connects (Providers). It’s really important; if you haven’t subscribed to that, they come through the email and they give you notifications. I strongly recommend you signing up for it. Here it is right here all the information, the new card and whatnot, there’s no gender on this and so forth.
Coach Laureen: Guard your card.
Coach Jo-Anne: Seriously, I’m dealing with identity theft and it’s not fun and it takes forever to clear so it’s really guard the card. You will be able to access the Health Plan Management System (HPMS) for technical information related to the Plans, and this is all web-based. I presented a list here, it’s really extensive but it supports the following business processes for all private health and drug plans. It’s everything from contract and plan enumeration and management. Formulary submission, marketing material, fiscal soundness, complaint tracking, financial plan bid and plan data reporting audit; it’s just everything operational data. It’s research and evaluation. It’s quite extensive.
I think Alicia also has here another link where you could submit any additional comments or questions to the team because it is going to be a learning curve, and of course all the information you want to know, and there’s a lot. If I could be on here for an hour-and-a-half going through everything, this is just really an overview, go on to the www.cms.gov website and read about it and sign up for MLN because you’ll get the emails and you’ll be up-to-date with everything. Coach Laureen: I like Sally’s suggestion to laminate them.
Coach Jo-Anne: Yeah.
Coach Alicia: I got one thing to add. At PAHCOM they made a point to say no one is going to know when the patients are going to start getting their cards, they’e not telling you and that is also to protect the identity, so that makes everything panic because the patients are going to call you and say, “George got his card last week. I haven’t got mine.” Or “So-and-so has his for three months, I haven’t gone mine. Is there a problem?” They said they are not notifying you when the cards are going out to protect the cards because of theft, they already recognized it’s going to be a problem.
Coach Jo-Anne: That’s really important because I’m sure those patients are going to be calling.
Coach Laureen: Yeah.
Coach Alicia: So, they’re like, she said get on that list and let them start giving you the updates and everything because even if you call, they’re not going to tell you that the cards are being mailed out to so-and-so or sections or what area is first. It will be random.
Coach Jo-Anne: That’s wonderful.