Prevent Medicare Claims Denials in 2020

Prevent Medicare Claims Denials in 2020

Starting Jan. 1, 2020, Medicare claims submitted with the patient’s Social Security Number will be rejected. A simple way to prevent claims being rejected is to make sure all your Medicare patients have their new card.
The Centers for Medicare & Medicaid Services (CMS) has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI), in place of Social Security Numbers (SSNs), for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s SSN or their new MBI on claims.

MBIs Required in 2020

The MBI phase-in period is complete, and all claims are expected to identify the beneficiary using their MBI. If the MBI is not used on claims after Jan. 1, the claim will be denied with one of the following reason codes:

  • Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber)
  • Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”

CMS says, to date, 87% of claims are submitted with the MBI. The other 13% of claims still using the SSN will be rejected and payment will not be received beginning Jan. 1, 2020.
If a patient does not know their MBI, you can look it up via the Medicare Administrative Contractor’s portal now and after the transition period. You can also find a patient’s MBI on the remittance advice.
If your patient doesn’t have their new card, give them the Get Your New Medicare Card flyer in English or Spanish.

CPB : Online Medical Billing Course

Barbara Cobuzzi

About Has 105 Posts

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is an independent consultant, CRN Healthcare Solution, Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers. Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.

No Responses to “Prevent Medicare Claims Denials in 2020”

  1. Jane says:

    The problem is you can’t look up the MBI without the social. The social is no longer provided at some facilities.

Leave a Reply

Your email address will not be published. Required fields are marked *