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Providers at Risk for Noncompliance of Medicare Beneficiary Identifier

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  • February 7, 2019
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Providers at Risk for Noncompliance of Medicare Beneficiary Identifier

As of January 25, only 62 percent of healthcare providers submitted fee-for-service claims with the new Medicare Beneficiary Identifier (MBI), according to the Centers for Medicare & Medicaid Services (CMS)(MLN Connects, Feb. 7). Is your provider among the 28 percent who haven’t begun to use the MBI for Medicare transactions?
Providers have until Dec. 31 to get on board, or risk noncompliance.

It’s the Law

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers from all Medicare cards by April 2019 (see also, H.R.624 Social Security Fraud Prevention Act of 2017). CMS started mailing beneficiaries new Medicare cards last year, and reports that all cards have been mailed.

It’s Your Livelihood

Providers may use either Social Security Number-based Health Insurance Claim Numbers (HICN) or MBIs on claim forms through Dec. 31. Beginning Jan. 1, 2020, however, claims with HICNs will be rejected, identified by the remittance advice:

  • Claim Adjustment Reason Code 16 Claim/service lacks information or has submission/billing errors; and
  • Remittance Advice Remark Code N382 Missing/incomplete/invalid patient identifier.

The MBI requirement applies to claims submitted on or after Jan. 1, 2020, for services rendered prior to the Dec. 31 cutoff, but does not apply to appeals, claim status queries, and span-date claims.

Learn More

AAPC has been covering this new billing requirement from the start. Here are additional articles on our blog that may interest you:
Recognize the New MBI
Prepare for New MBI System Format
MACRA Requires CMS (and You) to Replace SSN with MBI

CPB : Online Medical Billing Course

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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