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    Physician practices are now beginning to see patients using a new Medicare card and number. Organizations should be prepared to handle both the new and old numbers in their revenue cycle and understand how to access these new numbers to streamline the billing of Medicare claims.

    Background and overview
    The Social Security Number (SSN)-based Health Insurance Claim Number (HICN) has been used for decades as the beneficiary identifier for administering the Medicare program. The Centers for Medicare & Medicaid Services (CMS) uses the HICN with multiple parties, such as the Social Security Administration, Railroad Retirement Board, states, Medicare providers, Medicare plans and others. With the HICN included on the paper Medicare beneficiary identification card, there has been increased concern regarding medical identity theft. This concern culminated in the inclusion of a provision in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requiring the removal of the HICN from Medicare beneficiary ID cards.

    In implementing this MACRA provision, CMS will:

    • Generate new Medicare Beneficiary Identifiers (MBIs) for approximately 150 million beneficiaries, including currently active, deceased or archived and new beneficiaries
    • Issue new, redesigned Medicare cards to existing and all new beneficiaries
    • Offer multiple ways for providers and patients to access the MBI

    CMS decided to issue new cards with a new, randomly generated MBI that replaces the HICN. The agency is mailing the new Medicare cards with the MBI in phases by geographic location. There are three methods practices can use to obtain a Medicare patient’s MBI:

    1. Ask your Medicare patients to provide their card or MBI. Keep in mind that while CMS has issued an MBI to all applicable individuals, patients may not yet have a physical card due to the geographical rollout. If your patients live in an area that has already had its mailing and they have not yet received their card, you can print out the “Still Waiting for Your New Card?” handout in English or Spanish or refer them to 1-800-Medicare (1-800-633-4227).
    2. Use your Medicare Administrative Contractor's (MAC) secure MBI Lookup Tool. Practice staff can look up MBIs for Medicare patients when they don’t provide them. Note that you will be required to sign up for the MAC Portal to use the tool. The lookup tool will continue to be available after the transition period ends on December 31, 2019.
    3. Check the Medicare remittance advice. From October 2018 through the end of the transition period (December 31, 2019), Medicare will return the MBI on every remittance advice when you submit claims with valid and active HICNs.

    In light of this information, the Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders if their organization is experiencing challenges with the new Medicare card numbers. Nearly two-thirds (66%) replied no, 14% responded yes and the remaining 20% were unsure. As a follow-up question for those who responded “yes” to experiencing challenges, MGMA asked what their biggest challenge was. More than one-third (38%) indicated that patients not presenting their new card was their biggest challenge, followed by 17% who indicated their software can’t accept the new card number and 12% who reported challenges using the MAC Lookup Tool. The remaining 33% replied with “other” challenges, many cited data entry errors (e.g., O vs. 0).

    For those who replied “no” to experiencing any challenges with the new Medicare card numbers, they were asked if they use the MAC Lookup Tool. To this, 30% responded yes, 49% responded no and 21% were unsure. This poll was conducted on Dec. 11, 2018, with 818 applicable responses.

    Key practice checklist items

    1. Conduct patient outreach:
      • Review your options when informing patients about the new Medicare card (i.e., download the posters, flyers and tear-offs available in the MGMA Toolkit referenced below).
      • If the address you have on file is different than the address you get in electronic eligibility transaction responses, encourage your patients to correct their address in Medicare's records at SSA using (This may require coordination between your billing and office staff.)
      • Remind patients that Medicare will never contact them and request personal information. They should protect their new Medicare number like a credit card and only share it with trusted providers.
    2. Get ready to use the new MBI format:
      • You should already be receiving MBIs from your Medicare patients.
      • Review your systems and workflow to ensure that you are ready to accept the 11-digit alphanumeric MBI as well as maintain the HICN throughout the transition period.
      • Ensure your practice management system software vendor is ready for the MBI and can accommodate both the HICN and the MBI.
      • Test your systems to minimize the chance of billing issues.
      • If you contract with billing vendors to submit claims to Medicare, ask them about their MBI preparations and ensure they are ready for the change.

    MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and regulations, among other topics. Participation is open to all healthcare leaders. See results of other polls and information on how to participate in MGMA Stat.



    Robert M. Tennant, MA
    Director, Health Information Technology Policy
    MGMA Government Affairs


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