New ID Numbers for Medicare Beneficiaries
Dear Members of Los Angeles County Podiatric Medical Association:
Let me start by wishing all a Happy New Year. I am an optimistic person and feel 2020 has good things in store for us as a profession. We have filed our class action lawsuit against Anthem Blue Cross for unfair business practices in regards to the payment level for custom orthotics. Keith Greer feels we have a strong case against them. We will keep everyone updated as news becomes available.
With the new year, comes new rules and regulations. By far, the most important change you will encounter and have to deal with immediately is Medicare's use of new identification numbers for Medicare beneficiaries. CMS states:
Your systems and business processes must be ready to accept the new Medicare number (which we call the Medicare Beneficiary Identifier or MBI in official guidance) by April 2018 for transactions, such as billing, claim status, eligibility status, and interactions, with our Medicare Administrative Contractor (MAC) contact centers.
There will be a transition period when you can use either the HICN or the MBI to exchange data and information with us. The transition period started April 1, 2018, and will run through December 31, 2019.
What happens after the transition period ends? On January 1, 2020, even for dates of services prior to this date, you must use MBIs for all transactions; there are a few exceptions when you can use either the HICN or MBI: FFS claim exceptions: Appeals – You can use either the HICN or MBI for claim appeals and related forms.
Claim status query – You can use HICNs or MBIs to check the status of a claim (276 transactions) if the earliest date of service on the claim is before January 1, 2020. If you are checking the status of a claim with a date of service on or after January 1, 2020, you must use the MBI.
Span-date claims – You can use the HICN or the MBI for 11X-Inpatient Hospital, 32X-Home Health (home health claims and Request for Anticipated Payments [RAPs]) and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before the end of the transition period (December 31, 2019). If a patient starts getting services in an inpatient hospital, home health, or religious non-medical health care institution before December 31, 2019, but stops getting those services after December 31, 2019, you may submit a claim using either the HICN or the MBI, even if you submit it after December 31, 2019. Since you submit home health claims for a 60-day payment episode, you can send in the episode’s RAP with either the HICN or the MBI, but after the transition period ends on December 31, 2019, you have to use the MBI when you send in the final claim that goes with it.
So if you have not sent out a 2019 claim yet, make sure it has the new MBI number on it unless it is an inpatient stay, which is one of the exceptions that allow the old numbers. We hope this information helps you start off your 2020 on the right foot. Pun intended.
It just so happens that we have the perfect event to help you navigate these changes. As your local association president, I can’t emphasize how valuable this year’s Treasure Hunt event has now become. An enlarged workshop program, California radiology and flouroscopy units, traditional Medicare updates, and practice management education at the right time to give us clarity. LACPMA members get a great rate at $99 for a wealth of information. Use member discount code: LACPMA99 to get the discount today.