New Medicare Cards may affect your Billing process!!

Most medical providers genuinely serve to improve their patients’ health. Fraud in healthcare system is identical to any other industry and some fraudsters take precedence to unjustly profit.  Healthcare crooks include patients, payers, employers, vendors, suppliers, and providers.  Orderly crime rings and computer hackers also play roles in committing health care fraud.  Due to this, Medicare has taken initiative to get rid of Social Security Numbers from Medicare Cards

Be prepared! as CMS has taken initiative to prevent identity theft and protect the essential program funding and financial information (billing) of our Medicare beneficiaries.  CMS is going to issue MBI (Medicare Beneficiary Identifier); new Medicare cards with a unique number which will be randomly assigned.  MBI is going to replace the existing Social Security based Health Insurance Claim Number (HICN) by April 2019.

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Describing briefly, MBI will have 11 non-intelligent characters which are generated randomly. It will be combination of numbers and upper-case letters.  Letters – S,L,O,I,B and Z are not used.

MBI Format:
New Medicare Cards may affect your Billing process!!

Pos.   1   2    3   4 5   6   7   8   9  10  11

Type: C A AN N A AN N A  A  N   N

How will the MBI’s characters be followed?

C – Numeric 1 thru 9
N – Numeric 0 thru 9
AN – Either A or N

A – Alphabetic Character (A…Z);
Excluding (S, L, O, I, B, Z)

CMS is going out of the way in helping healthcare providers by giving them necessary secured tools required to look up the new MBI.  They are trying to make the process facile for the patients, the providers, and the staff by providing a transition period of 21 months where they will be able to use either MBI or HICN for billing purposes.

Due to the new addition of MBI, all patients and healthcare providers are in dilemma – how will they handle their Revenue Cycle Management? Processed claims that are submitted with either HICN or MBI will change your system if there are problems with claims submitted using the MBI.  Then one has to keep track of when claims are sent in and managing other transactions that are in the process using the new MBI card; this can be a tedious job.   Therefore, outsourcing your medical billings can free resources and reduce administrative costs of your practice.  This way you can concentrate on improving patient care and expanding the practice, knowing that outsourcing will provide end to end customized billing services to elevate growth of your business.

Customized medical billing services include:

  • Account Receivable follow-up
  • Denials and appeals management
  • Eligibility verification with payers
  • Referral Submission & tracking
  • Electronic remittance and payment posting
  • Demographics and claims Entry/submission/reconciliation

These services aid in extensive reporting and dashboards, 24*7 availability with disaster recovery, free meaningful use compliant EHR, 98% first-pass acceptance, tremendous time/cost saving and cash flow improvement.

Providing such ease, RCM can easily blend in with new CMS system and take care of all billings without causing any issues or delays.  You don’t need to worry about:

Eligibility Verification

Eligibility verification is a crucial step in the medical billing cycle. It is critical because it directly affects the reimbursement.  It is very time – consuming task to accurately analyze if a patient is eligible for financial assistance and most healthcare providers may not have the training required for this process.  One needs to verify effective dates, benefits, calculations, administration, follow-up, plan execution and any other information pertaining to the patient’s screening process.  Using the new cards, everything will be maintained regularly and meticulously to ensure that there will be no downtime and all the information and procedures are intact.  For this reason, it is better to outsource medical eligibility verification so as to reduce the labor costs involved with building an in – house separate department for eligibility and it relieves medical professionals from administrative tasks and allows the healthcare providers to concentrate on growing their business and providing quality healthcare.

Claiming Process

As the healthcare industry continues to prosper in a global scale, healthcare providers are faced with the great challenge of maintaining the highest quality of healthcare services while still managing tasks for business operations.  It is important to have your medical claims free from errors, so there are no chances of payment delays and that you are ensured the timely inflow of payments for the services rendered to insured patients.  Even with the introduction of new cards, all the minute details will be processed and there will be assurance that the claims are free from errors and be approved immediately.  There will always be controlled access that restricts information accessibility to keep all clients’ information secured and confidential at all times.

Coordination of benefits

This assures that the Medicare pays the claim in a right way the first time, every time.  This is done by constantly updating the records; letting your doctor and other providers know the changes that have to be passed along to the Medicare. With the addition of new Medicare cards, there will be no obstacles and it will eventually speed up the process to get back the payment.

CMS does not expect that the MBI will change for an individual unless the MBI is compromised under investigation (E.g. religious reasons).  There are certain concerns such as the ability of physician practices to have access to MBI as soon as they are assigned.  Secondly, the ability of the practice to bill for patients who approach office after Jan. 2020.  Lastly, handling of cross-over claims during the transition period.  In spite of all these minor hurdles, this cost effective process that involves the least disruption, as well as necessary assistance for healthcare providers and Medicare beneficiaries, will be up about and running soon.


About the author

Tejhas Vyass, a technocrat and result oriented with over 11 years of experience in US Healthcare Industry works with iPatientCare users during their inbreeding, involving, enrollment, training, configuration, and go-live assistance. He possesses an in-depth and up-to-date knowledge of the US medical insurance and revenue cycle management for small and medium sized physicians’ offices. An effective communicator with exceptional relationship management skills, iPatientCare users admire him for his knowledge, brilliance, and willingness to help during any and every step of implementation and support.

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