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Regulatory Compliance – MBI and what it means to HIT

February 13, 2017
Crystal Ewing
From the January 2017 issue of HealthCare Business News magazine

By Crystal Ewing

With identity theft on the rise, especially among the vulnerable elderly population, the Centers for Medicare and Medicaid Services (CMS) recently announced plans for an important change to the Medicare program. It replaces the current health insurance claim number (HICN) on Medicare cards with a new Medicare beneficiary identification (MBI) code as dictated by the Medicare Access and CHIP Reauthorization Act (MACRA). The current HICN violates every best practice by using a member’s Social Security number plus a couple of additional characters to create the ID. Which means a lost or stolen Medicare card could become a window into that member’s medical and financial information.

Yet making the change is no small task, since it affects 60 million active Medicare beneficiaries as well as 90 million who are deceased/archived, but whose records are still at risk. That’s a problem for providers and health IT professionals because while CMS has been very specific on the “what” and “when,” it has been less so regarding the “how.” The ambiguity adds to the challenge, especially considering the transition period is scheduled to begin in April 2018 and conclude Dec. 31, 2019. The following are some of the key considerations.



How the new MBI will be obtained.
This is the one most likely to keep providers and their HIT teams up at night. With the HICN, providers can retrieve information from an eligibility-verification transaction if beneficiaries don’t bring their cards to the office visit. That will not be the case with MBIs. Providers are being told to obtain them directly from patients by asking for their new Medicare cards. CMS won’t be sending the MBIs straight to providers out of concerns for identity theft. If beneficiaries
don’t bring their Medicare cards, or don’t know their MBI, the only way to update their records is after the fact — referring to the new MBI by checking the remittance advice.

This seems convoluted since it will create delays in updating the information, and extra work. It will also make the MBI easy to miss since the timing doesn’t match normal workflows. A better approach would be for the new number to be provided during the eligibility verification process. That is when providers are closely examining the eligibility document to ensure the patient has the proper coverage for the services about to be rendered, and validating the type of coverage as well as the payer. This second option is what many in the industry are advocating.

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