A big change in Medicare beginning April 1, 2018, is presenting new reimbursement challenges. Over an 18-month period, Medicare Beneficiary Identifiers (MBIs) will replace Social Security numbers (SSNs) from the Health Insurance Claim Number (HICN). With over 150 million Medicare recipients of which 60 million are active Medicare patients, this change presents new significant challenges for emergency room facilities and all medical providers. Those providing episodic care through hospital emergency rooms, freestanding ERs and urgent care settings, without an established relationship with patients, are expected to encounter many more billing errors and reimbursement delays. Besides medical providers, the Social Security Administration, state Medicaid agencies, and health plans will be impacted by this new Medicare change.
During the transition period, providers will be able to submit claims based on the original SSN Claim Number (HICN) or the new MBI number, but such a policy is likely to result in reimbursement glitches. Providers without ready access to the new MBIs to adjudicate claims can expect more delays with Medicare reimbursement.
Some of the key points to be aware of with the new MBIs include:
- Beginning January 1, 2020, providers must submit claims using only the new MBIs.
- Providers will not be able to query CMS for MBIs. Patients will be responsible for presenting their new cards during emergency room visits and for other healthcare services.
- Verification of new MBIs are expected to increase time for patient registration and billing.
Source: New Medicare Cards CMS.gov. 2017.
Article By Rob Ross and David Windham, 360 Medical Billing Solutions Co-owners and VPs