Changed Medicare Beneficiary Identifier (MBI) I and now your office is hit with a new deductible. Can you solve this problem? Yes you can Win This!!
A Medicare patient presents to your office in the same year having previously satisfied their annual deductible with their long-time existing Medicare number. Today, they present with a new card and new number as their old was stolen. You proceed to furnish whatever services are necessary. The claim is submitted and processed with the new MBI. You then receive an EOMB stating that all services went to their deductible. What happened here, what can you do to resolve this and how could this have been prevented?
To prevent your office with being caught in the middle of this, is to treat this patient as though they were a new patient from the perspective of checking their benefits. Once you had verified that the system was once again hitting them with the deducible, you could have them sign an CMS 1696 form (see below) which would alert Medicare that they did not transfer the payment history from the old MBI to the new one. Doing this in advance would avoid all the headaches the patient may have not only with your office but with others. And by fixing this, in advance the patient (and their family) will be forever thankful to you!
Why did this happen?
Assuming that this new Medicare MBI is accurate, what likely happened is Medicare may not have transferred all the beneficiary information from the old number to the new MBI. Another possibility is that the Social Security information may not have input this new beneficiary number into the patient’s Common Work File.
In either case, this needs to be a headache for the beneficiary and/or their family to resolve.
Can I take this “problem” on and my practice become a hero?
Absolutely, You can have the patient sign CMS-1696 Authorized Representative Form available at: https://www.ssa.gov/forms/ssa-1696.html
By doing so the patient is granting you the ability to act on their behalf to resolve the issues at hand.
Your discussion with CMS would simply be that the patient had previously met their deductible for the year with MBI number … And you would provide the necessary proof. CMS and Medicare would of course have that information, which is available in a number of ways. Most commonly from your ER program, which searches this information from CMS website. You would then provide them with the EOMB for the new claims with the new MBI.
As stated earlier, rather than having to “fight” to collect after the fact, is for your office to check the patient’s deductible status with their new BMI when they first contacted your office for a new appointment or when you were confirming an upcoming appointment. Simply having your front office scheduler asking if there been any changes to your insurance coverage since your last visit may prompt the patient to provide you with this information. It also points to the importance of using your EHR to verify coverage of even long-standing patients immediately prior (the day prior) to their next appointment.
Had this situation been known in advance of providing services, the patient and your office would have had more time to resolve this issue.
For patients with new MBI replacing a lost or stolen one, or simply because their number has been compromised, this is not an uncommon situation. Your front office should be alerted on how to handle this issue and a policy be implemented for your practice.
