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Richter ShareSource Blog

Preparing for Change: Medicare Beneficiary Identifier

Posted by Donna Berry, Revenue Cycle Manager-Home Health and Hospice on Feb 14, 2018 8:41:00 AM

In an effort to fight medical identity theft for people with Medicare, the Medicare Access and CHIP Reauthorization Act of 2015 requires the Centers for Medicare and Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.

Beginning in April 2018, CMS will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to all Medicare recipients. The new MBIs will replace the SSN-based Health Insurance Claim Numbers for transactions like billing, eligibility status and claim status after a transition period.

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Topics: News & Events, Medicaid Consulting

CMS to Implement Changes to Beneficiary Identifiers

Since the inception of the Medicare program in 1965, beneficiaries have been identified by a Social Security number-based identifier known as the Health Insurance Claim (HIC) number.  This unique identifier has been used to determine the beneficiary for all Medicare transactions such as eligibility, billing and claim status inquiries. 

As a means to help fight identity theft, The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires the Centers for Medicare and Medicaid Services (CMS) to remove the beneficiary’s Social Security number from all Medicare cards by April 2019 and replace it with an identifier that will help to secure the integrity of the beneficiary health data.  This new number will be known as the Medicare Beneficiary Identifier (MBI). 
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Topics: Medicaid Consulting, News & Events

How it works: Medicare Level of Care (LOC) in PointClickCare® for the Management of No Pay and Exhaust Bills

The Level of Care (LOC) in the PointClickCare® Census and Rates resident tab is used for the management of No Pay and Exhaust claim billing for residents, after a Medicare Part A skilled stay. The LOC has no other function but to drive this process. Skilled Nursing Facilities (SNFs) are required to submit claims to Medicare for residents to report the benefit period even though no benefits may be payable. The Centers for Medicare & Medicaid Services (CMS) maintains a record of all inpatient services for each beneficiary, whether those services are covered by Medicare or not.

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Topics: Implementation, Medicaid Consulting, PointClickCare

Understanding Ohio's Nursing Facility Medicaid Adjudication Process and What to do if you Receive a Medicaid Overpayment Review Letter

Posted by Candace Jones on Mar 21, 2017 9:34:10 AM

All skilled nursing facility (SNF) administrators should be aware of the state of Ohio Department of Medicaid (ODM) adjudication process, but many may not know that the findings of the state’s audit can – and should be – refuted.

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Topics: Revenue Cycle Management, Financial Consulting, Medicaid Consulting

IMPACT Act Basics - What You Need to Know

What is the Impact Act? Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 is a bipartisan bill passed on September 18, 2014, and signed into law by President Obama on October 6, 2014.

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Topics: Medicaid Consulting

Acceptable Medicare Certification and Re-Certification Statements

Posted by Jacklyn Brown, RN on Dec 9, 2016 5:00:00 AM

Have you reviewed your certification and recertification statements for Medicare skilled nursing care recently?   My recent experiences with Medicare payment denials have indicted this continues to be an area many providers should focus on for process improvement.  Denials based on certification and recertification statements cannot be appealed.  The risks associated with a breakdown of certification and recertification process can significantly impact the operations of a Skilled Nursing Facility (SNF).  Ensuring the certification and recertification statements for Medicare skilled nursing care are not only completed but accurately completed can prevent the loss of revenue.  A review of this critical process may be the difference between a payment and a denial.  As Skilled Nursing Facilities continue providing the highest quality care possible amid a myriad of budget cuts, preventing denials of payment has to be a priority.

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Topics: Medicaid Consulting

What Is The PAMA Act and VBP?

The Protecting Access to Medicare Act (PAMA) of 2014 was enacted on April 1, 2014 – this act authorized the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program.  This law requires that the Centers for Medicare and Medicaid Services (CMS) adopt a VBP payment adjustment for SNF’s as of October 1, 2018 – PAMA also requires CMS to:  

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Topics: Medicaid Consulting

New Interactive Medicaid Information Resource Now Available

Posted by Richter on Oct 21, 2016 7:00:00 AM

Medicaid is a Federal program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. 64 million people are covered, including 4.3 million newly eligible adults, according to the 2015 CMS Actuarial Report Average Enrolled.

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Topics: Medicaid Consulting