Social Security numbers must be removed from all Medicare cards by April 2019, according to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
“Medicare patients will need to be educated on the new identifier to use when accessing care. They need to be informed why the change was made to stop potential identity theft,” says Cindy Ovalle, patient registration director at PIH Health Hospital – Whittier (CA).
At the point of access, Medicare patients now will be assigned a new Medicare card with a Medicare Beneficiary Identifier (MBI) instead of the current Health Insurance Claim Number, which includes the patient’s Social Security number.
Roger Stone, system manager for admission services, patient registration, and central access at CoxHealth in Springfield, MO, predicts MACRA will change his department, and all other patient access departments across the country, “tremendously.”
“We are already proactively brainstorming the work that needs to be done to be ready for this change,” he says.
Patti Consolver, FHAM, CHAM, senior director of the patient access intake center at Texas Health Resources in Arlington, TX, says having more than a year to plan for MACRA risks delays.
“It will go the way of ICD-10 and sit on a shelf,” Consolver warns. “We just need to get ahead of it and provide timely communication.”
Many Hours of Extra Work
Stone doesn’t blame CMS for making this move.
“They are following what many other health insurance companies have already done to try and help protect patients and their identity,” he says.
However, there is no question that it means more work for many areas of the hospital, “not only our patient access teams, but many other departments within the revenue cycle and IT departments,” Stone says.
Time-consuming phone calls to payers will be needed, but not by registrars.
“The even bigger challenge with this is that most payers will not talk to our staff, but instead will want to the talk to the patients,” Stone explains, noting patient access will take a more indirect role. “One way our staff can be beneficial to the patient is walk them through the phone call, instead of telling them to go home and call their insurance provider.”
If patients present their updated Medicare card, patient access staff will have to deactivate the old Medicare insurance in the registration system. They will then re-enter it with the new MBI, instead of simply asking for the Health Insurance Claim Number.
Ovalle explains, “The registration team will need to make sure we are updating with the most current insurance information. Hopefully, the patient has his or her new ID card available.”
Patient access will have to ask the patient for their new Medicare card with the MBI. Staff currently ask for the Health Insurance Claim Number.
“If patients do not have their new MBI number or card with them, the process may take longer,” Ovalle warns. Patient access will have to run eligibility with the Health Insurance Claim Number.
“As with any process, there is a learning curve for staff,” Ovalle explains. “Processing time may slow down as the new protocols are learned and refined.” Here are some expected challenges for patient access departments.
- Getting staff to update the information for established patients.
“If people are used to using card copies from previous visits — we have that capacity in some facilities — it may be an issue,” Consolver says.
- Dealing with “downstream” issues due to payers not updating the crossover information.
“This will mean claims that previously went to Medicare as secondary may be delayed,” Consolver says.
- Preparing for possible coordination of benefits issues.
“The commercial secondary may not recognize the MBI, because they still have the old Health Insurance Claim Number,” Consolver explains.
Ovalle hopes this won’t happen too often, because Medicare most likely will use a common member identifier that will flag it as a Medicare FFS policy.
“By the time the change is implemented, most, if not all, of the payers should have the capability to match the policy numbers,” Ovalle says.
- Making sure that the ID number is updated, and a copy of the new insurance card is obtained, for every patient with a traditional Medicare plan on file.
“If patients have Medicare Replacement/HMO plans, we need to be sure their records get updated as well,” Stone says.
Patient access currently requires the Health Insurance Claim Number to be listed, along with the policy number for their replacement/HMO plan.
“This alone will bring many challenges,” Stone notes. “We will have to rely on other insurance companies to update their databases so when our teams go to check for eligibility it is accurate.”
- Training patient access staff to field questions from patients.
“We will work to get this information out across the system, to all staff involved,” Stone says, noting that tip sheets and workflow maps are under development. “I don’t believe patients are educated enough about their healthcare insurance coverage from insurance carriers.”
This puts the onus on patient access to explain the changes. CMS said it will use the message field on the eligibility transaction responses to inform providers when a new Medicare card has been sent to each beneficiary. Patient access will be instructed to look for this message.
“This will help us make sure the patient is aware a new card was sent to them if they have not already received it,” Stone says.
- Patti Consolver, FHAM, CHAM, Senior Director, Patient Access Intake Center, Texas Health Resources, Arlington, TX. Phone: (682) 236-1703. Email: [email protected].
- Cindy Ovalle, Patient Registration Director, PIH Health Hospital – Whittier (CA). Phone: (562) 698-0811, ext. 12563. Fax: (562) 464-5110. Email: [email protected].
- Roger Stone, System Manager, Admission Services/Patient Registration/Central Access, Cox Health, Springfield, MO. Phone: (417) 269-7476. Email: [email protected].
