The Centers for Medicare and Medicaid Services is readying the healthcare industry for the removal of Social Security numbers from Medicare cards by April 2019.

However, the changeover and necessary tweaks to information systems will primarily come during the next couple of years, and many providers are unaware of the immediacy of these changes.

The Cooperative Exchange, a trade association representing claims clearinghouses, is putting the word out on the new Medicare Beneficiary Identifiers, called MBIs, that will replace the SSN, and the group has much more questions for CMS than answers at this point.

“We don’t even really understand what their distribution strategy will be,” says Crystal Ewing, manager of data integrity at revenue cycle management vendor ZirMed and chair of a Cooperative Exchange committee working through the issues.

Crystal Ewing

There are about 60 million people with Medicare cards displaying a Social Security number, and CMS promises it will provide educational programs for providers and beneficiaries, Ewing says, but again, details are sparse. “Right now, all the information is extremely light on how this will be done.”

In April 2018, CMS will start generating new MBIs for all living and deceased Medicare beneficiaries, with information systems and business processes hopefully ready to accept and process the MBI. While distribution of MBIs will continue until the end of 2019, the start date is only about 18 months from now. Following a 20-month transition period, CMS will no longer accept the older cards.

The new Medicare Beneficiary Identifier will be 11 digits long and contain a combination of alpha numeric characters.

For now, providers need to understand that the change is coming and may require some coding changes to information systems, Ewing says, adding that providers “need to understand your current operational processes and how you store and exchange the number.”

Providers also have to start thinking about patient education and the need to have electronic eligibility verification available if a patient shows up for care without a card or with an old card. In general, provider information systems routinely process new cards as patients switch commercial insurers or get a Medicare/Medicaid card. A provider merely selects a new insurer and inputs the new identification number.

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For now, here are questions from Cooperative Exchange that providers should be asking their vendors sooner rather than later:

  • How long will my vendor need in order to prepare systems for the new cards? What software development and infrastructure changes are needed, and what business logic and workflows need to change? What’s the magnitude and time needed to map the process through its entire lifecycle? How much will it cost?
  • Will my system be functional and able to accept a dual processing of the Medicare number, i.e., the Healthcare Insurance Number and the Medicare Beneficiary Identifier? What editing will be involved such that the system adjusts accurately and quickly? During a short CMS-designated transition period, or for a longer term?
  • If all new Medicare cards are distributed to beneficiaries gradually, will that be better for my system’s capacity vs. if they are all distributed at the same time? Will the system be able to accommodate both the card number change and the volume of card number changes?
  • Will my system coincide with CMS’ eligibility verification process and its authorization process for old and new card numbers?
  • How will this change to new Medicare cards impact patient care? Can we avoid claims denials?
  • How will this change to new Medicare cards impact provider revenue integrity?

The Cooperative Exchange has sent a long series of questions on the changeover to CMS. The agency does not yet have a timetable for responding to the questions, according to a spokesperson.

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