October 2017

SNF PPS RUG RATES
The SNF PPS RUG rates effective 10/1/2017 are now available. Make sure to update your rates before doing October’s billing by checking on your local MAC’s website. For Novitas Solutions, please go to www.novitas-solutions.com and choose Cost Reporting and SNF RUG rates in the menu on the left side of the Medicare Part A home screen.

Transition from HICN to MBI
As identity theft becomes more and more widespread, the Centers for Medicare & Medicaid Services (CMS) are transitioning from Health Insurance Claim Numbers (HICN) that use a social security number to Medicare Beneficiary Identifier (MBI). CMS will begin mailing the new Medicare cards in April 2018 in geographical waves to help protect against scams. Any new Medicare receipients effective after April 1, 2018 will only get an MBI and therefore all billing systems must be ready for the new MBI by April 1, 2018. Each MBI will be randomly generated consisting of 11 characters containing letters and numbers. It will have numbers 0-9 and letters from A to Z, except S, L, O, I, B and Z. Each character is very specific. Characters 1, 4, 7, 10 and 11 will always be a number. Characters 2, 5, 8 and 9 will always be a letter. Characters 3 and 6 can be a letter or a number. Here is an example: 1EG4-TE5-MK73. The dashes are not part of the number and should not be entered into computer systems. MBIs will no longer have a character that identifies Railroad Retirement Board (RRB) patients. It will need to be identified from the logo on the new Medicare card or from the message “Railroad Retirement Medicare Beneficiary” during an eligibility inquiry. They will continue to be sent to the RRB Specialty Medicare Administrative Contract, Palmetto GBA. Spouses that used to have similar HICNs will each receive their own randomly generated MBIs. CMS is planning a wide-scale outreach to help encourage people to share their new MBI when receiving medical care. The transition period to get all HICNs converted to MBIs is April 1, 2018 through December 31, 2019. Once the new MBI is received cease using the HICN. CMS is doing several things to help make this a smooth transition. Starting June 2018, eligibility checks can be done using only first name, last name, date of birth, and social security number. In October 2018 through the end of the transition period, any claims submitted with the HICN will appear on the remittance advice with both the HICN and the MBI. These new MBIs are Personally Identifiable Information and should be protected just like the HICNs. This is a huge transformation for all parties involved so keep communications lines open to help make this as smooth as possible.

Billing Trends
Several of the common Managed Care organizations are increasingly requesting medical records before they will pay claims. Most of this type of correspondence still comes through the regular postal service so be sure to keep an eye out. It is important to always make yourself a copy of the documentation you are sending for future reference; insurance companies often have a problem with documentation that was sent, so it’s good practice to have it handy when this happens. Also, make sure you thoroughly review your contract with these Managed Care companies. You will find helpful billing hints and reimbursements breakdowns that may be worthwhile to share with other departments.

 

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