Physi­cians still wait­ing for guid­ance on Medi­care ID card changes

Modern Healthcare - - NEWS - By Vir­gil Dick­son

The govern­ment’s plan to re­move So­cial Se­cu­rity num­bers from Medi­care iden­ti­fi­ca­tion cards rolls out in nine months, but the CMS has yet to give providers clear guid­ance on their re­spon­si­bil­i­ties to en­sure that billing priv­i­leges aren’t af­fected.

Since the be­gin­ning of the Medi­care pro­gram, So­cial Se­cu­rity num­bers have been used as the ben­e­fi­ciary iden­ti­fier for ad­min­is­ter­ing ser­vices. The Medi­care Ac­cess and CHIP Reau­tho­riza­tion Act re­quired the CMS to re­move the num­bers from Medi­care cards be­cause of iden­tity theft and fraud risks.

Start­ing in April 2018, the CMS will be­gin to is­sue Medi­care cards with new ID num­bers. Ap­prox­i­mately 60 mil­lion ben­e­fi­cia­ries will re­ceive the new cards by April 2019.

With­out clear in­struc­tions on how to pre­pare for the change, physi­cians risk los­ing their abil­ity to bill Medi­care. Claims with the old num­bers won’t be ac­cepted start­ing in 2020. Prac­tices also need to up­date their elec­tronic health record sys­tems to ac­cept the new ID num­bers.

Doc­tors know the changes are com­ing, but many have done noth­ing to pre­pare.

Dr. Charles Roth­berg, an oph­thal­mol­o­gist who is pres­i­dent of the Med­i­cal So­ci­ety of the State of New York, said the CMS could do more to ed­u­cate providers about the change, given the im­pact it could have on physi­cian prac­tices.

“We don’t have much in­for­ma­tion as to how they plan to roll this out,” he said.

A CMS spokesman dis­agreed that guid­ance has been lack­ing. He said the agency has been lis­ten­ing to con­cerns raised in re­cent weeks out­lined by the pro- vider com­mu­nity and has amped up mes­sages, tactics, guid­ance and other provider out­reach.

On June 15 the agency did re­lease a five-point bul­letin on steps that prac­tices should take to pre­pare for the change. The ad­vice in­cluded go­ing to the CMS’ web­site for up­dates, at­tend­ing quar­terly calls and test­ing cur­rent billing sys­tems to be sure they can han­dle the new for­mat.

But physi­cians still need more guid­ance, Roth­berg said. The CMS bul­letin didn’t clar­ify how long-term-care fa­cil­i­ties should help pa­tients who come in for treat­ment but don’t know their new ID num­bers. Nurs­ing home providers may not keep track of new pa­tient ID num­bers, since Med­i­caid pays for most low-in­come se­niors’ care, he said.

Providers had been push­ing the CMS to make the change via a rule­mak­ing process, giv­ing the agency a chance to lay out a sub­stan­tive roll­out plan and let­ting clin­i­cians weigh in.

While deal­ing with ICD-10, the roll­out of the Merit-based In­cen­tive Pay­ment Sys­tem and al­ter­na­tive pay­ment mod­els un­der MACRA, as well as on­go­ing EHR mean­ing­ful-use ac­tiv­i­ties, ven­dors may not be able to ad­dress this lat­est change in a timely way, ac­cord­ing to Robert Ten­nant, di­rec­tor of health in­for­ma­tion tech­nol­ogy pol­icy at the Med­i­cal Group Man­age­ment As­so­ci­a­tion.

Even with­out a for­mal comment pe­riod, Ten­nant has seen the CMS at­tempt to ad­dress some provider con­cerns.

The CMS orig­i­nally had no plans to cre­ate a database that would al­low providers to look up the new num­bers if a pa­tient lost their card or didn’t bring it in for an ap­point­ment. The agency re­versed course last month, an­nounc­ing that it will cre­ate a se­cure database for both providers and ben­e­fi­cia­ries.

“That’s a big change we saw,” Ten­nant said. “It’s crit­i­cal that prac­tices be able to look up these num­bers.”

Since the be­gin­ning of the Medi­care pro­gram, So­cial Se­cu­rity num­bers have been used as the ben­e­fi­ciary iden­ti­fier for ad­min­is­ter­ing ser­vices.

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