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Providers Must Be Ready for SSN Replacements by April 2018

October 20, 2016:

The impending replacement of Social Security numbers with Medicare Beneficiary Identifiers has taken some by surprise, despite the switchover being stipulated in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Many may have overlooked the change in identification numbers because it was overshadowed by another provision in MACRA: the elimination of the sustainable growth rate (SGR) as a way to calculate physician payment updates.

The act mandates that SSNs be removed from all Medicare cards by April 2019. To meet this deadline, the Centers for Medicare and Medicaid Services (CMS) has set a phase-in time period beginning April 2018, by which date all health care providers must be prepared to accept patients’ new Medicare Beneficiary Identifiers while continuing to recognize the SSN-based Health Insurance Claim Numbers through December 2019. The current format is usually a Social Security number format of three (3) digits, two (2) digits, and four (4) digits preceded or followed by a letter. There are few exceptions, one being Railroad Medicare having a few variations. The new identifiers will consist of 11 characters made up only of numbers and uppercase letters; no special characters will be used (a sample number would be 1AC0D23EF45). For MBI format specifications, go to https://www.cms.gov/Medicare/SSNRI/MBI-Format-PDF.PDF.

The new Medicare identifiers will be used for transactions such as billing and checking eligibility as well as verifying claim status. All Medicare business partners, such as state Medicaid agencies, the Social Security Administration, and the U.S. Railroad Retirement Board, will recognize MBIs.

There will be a 21-month transition period between April 2018 and December 31, 2019, during which time Medicare will accept claims listing either MBIs or HICNs. During this time, either identifier can be used to check eligibility. This does not mean providers can kick back and wait until November 2019 to start preparing, though. Beneficiaries are slated to begin receiving new Medicare cards in April 2018, and will be able to use the new cards immediately. This means providers and Medicare business partners must be set up to handle the MBIs by the spring of 2018. These new cards will be sent to both current beneficiaries as well as new Medicare patients. Practices should always check an insured’s card yearly for any changes; Medicare patients should be in that mix, too, starting with visits taking place after April 2018.

Between now and April 2018, providers must determine what changes their practice management systems need to make to accommodate the new MBIs, make those changes, and test their new systems. Practices that use third parties to bill Medicare must ensure their practice management systems are up to speed. Because all providers have to be able to accommodate both identification number types, providers should contact their electronic medical record (EMR) vendors now to confirm the steps they are taking around this new implementation.

Note than the MBIs are considered personally identifiable information under the Health Insurance Privacy and Accountability Act and must be protected as such.


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