In early September, the Centers for Medicare and Medicaid Services (CMS) and Wisconsin Physicians Service Insurance Corporation (WPS) announced a significant data breach affecting nearly 950,000 Medicare beneficiaries. This incident, stemming from a vulnerability in specific software used for file transfers during Medicare claims processing, exposed sensitive personal data, including names, Social Security numbers, Medicare Beneficiary Identifiers (MBIs) and dates of service. As a result of the breach, MBIs for affected beneficiaries will be updated in October 2024, a change that could cause substantial disruptions for both healthcare providers and patients.
Ryan Klaustermeier, MSN, RN, Vice President of Professional Services at Axxess, outlined important steps organizations should take to smoothly navigate the transition and minimize claim rejections and billing disruptions.
Important Steps for Organizations
As an initial step in managing the MBI transition, Klaustermeier advises that organizations should closely monitor their Medicare claim submissions during the changeover period, to ensure all payments are processed smoothly. Organizations need to ensure their current electronic medical record (EMR) and billing systems are updated with the new MBI numbers.
“Organizations may not realize that they’ve been affected until they receive what’s called an RTP, where the claim is returned to the provider,” Klaustermeier said. “That’ll show that the beneficiary has an expired MBI. Once identified, the claim can be resubmitted with the new MBI.”
Klaustermeier highlights that tools like Axxess DDE can be used to help monitor claim submissions, enabling organizations to resubmit rejected claims directly from the EMR.
“Use of Axxess DDE and Axxess RCM enables providers to quickly and effectively identify RTPs, correct them and resubmit them so that they can regain cash flow as quickly as possible,” Klaustermeier said.
Organizations are also encouraged to proactively reverify the eligibility of all Medicare patients to ensure the updated MBI numbers are accurately reflected in the system, preventing any future claim rejections due to outdated information.
Organizations can leverage their Medicare Administrative Contractor’s (MAC’s) e-services portal to identify new MBI numbers.
Klaustermeier also advises organizations to take the time to communicate with staff on the transition. Staff should be trained on new MBI verification processes to further avoid claim denials.
For additional information on provider resources, click here.
Communicating With Beneficiaries
“The beneficiary may not think, ‘Hey I got this new card in the mail and I need to let my home health or hospice agency know,’” Klaustermeier said. “Then there are those [beneficiaries] who may not have the capacity to notify their agency. They may be cognitively or physically unable. Providers need to be proactive.”
Klaustermeier recommends that organizations develop clear, informative materials to distribute to patients, outlining key details and emphasizing the importance of sharing their updated information with the organization.
“Organizations should provide staff with materials like a flyer or one-pager, something they can have at the ready to hand to a patient or family member,” Klaustermeier said.
Essential elements to include in the materials provided to beneficiaries are resources for credit monitoring, identity protection, and fraud assistance, as well as Medicare customer service information.
While organizations can do their best to mitigate the effects of the MBI transition, organizations should be prepared for potential delays and issues. Klaustermeier emphasizes the importance of having a plan in place to resolve current and future disruptions.
“I think, ultimately, the biggest takeaway in all of this is to be vigilant and have a really solid benefit eligibility monitoring process in place at all times,” Klaustermeier said.
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