Medicare Compliance & Reimbursement

Question: Our practice recently had a Medicare claim denied for invalid patient information. What’s going on with this?

Georgia Subscriber

Answer: If you’ve ever gotten a claim denied for invalid patient information and you’re sure you submitted the correct Medicare Beneficiary Identifier (MBI) to the payer, you’re not alone. If this happens, you should first verify the spelling of the patient’s name, and that the patient’s name and MBI match, experts say.

One way this can happen is if a patient loses their Medicare card. In the past, they’d get a new card with the same ID number on it as they had before (which was their Social Security number). However, with the MBI, if a patient loses their card, Medicare will send them a new card with a totally new MBI on it.

Another problem: If two of your patients have the same name, your system may pull up the wrong MBI if you just input the patient’s name into the system. Make sure you know their legal name that Medicare recognizes, experts say. You may call a patient by one name, but their official name in the payers’ beneficiary demographics may be something different.

You can use your MAC’s MBI lookup tool if necessary, as long as you have the name, birth date, and Social Security number. Customer service will protect patient information and will not release a patient’s MBI to you if you call your MAC.