HICNs to MBIs for Medicare Eligibility: How to Handle the Switch

By now, you are probably aware that the Centers for Medicare & Medicaid Services (CMS) is no longer accepting SSN-based Health Insurance Claim Numbers (HICNs) for most transactions.

The HICNs have been replaced with randomly-generated Medicare Beneficiary Identifiers (MBIs), intended to improve the security of patients’ personal information and help prevent fraud.

Starting January 1, claims or eligibility transactions submitted without an MBI have been rejected. And since an estimated 65 percent of claim denials are never corrected and re-submitted for reimbursement*, this could result in a preventable and sizeable hit to your revenue cycle.

The long and tedious hunt for patient MBIs

Updated Medicare cards with the new MBIs were mailed to patients long before the deadline, so one might expect the transition to be simple.

However, it’s important to remember that patients are people. They are busy. They forget to bring their cards to appointments. Especially where hospitals are concerned, patient visits may be unexpected or emergent. Where does that leave you as a provider?

While patient cards may be the easiest way to get an MBI, it certainly isn’t the only way. It’s possible to use your Medicare Administrative Contractor’s MBI look-up tool, but this process relies heavily on precise patient or policyholder data, and checking numbers one-at-a-time is tedious at best.

You can also refer to historical remittance advice if you happened to treat the patient prior to January 1 and have access to the records.

If you’ve had to resort to these methods, you understand how cumbersome the process can be.

An easier way to turn HICNs into MBIs

Busy healthcare providers need practical procedures to keep things running smoothly. Automated tools can take the administrative burden off of your staff and allow them to move on to the next claim faster.

Unlike other revenue cycle management providers, ABILITY goes beyond basic MBI lookup to provide full-service eligibility processing. Not only does our enhanced eligibility service have a nearly 100 percent MBI match rate; when combined with ABILITY COMPLETE, it also offers batch Medicare eligibility checks, alerts to indicate other insurance coverage and more.

Discover how to perform real-time eligibility verification and collect MBIs all at once. Request a demo today.

* “Success in Proactive Denials Management and Prevention,” Glen Reiner, HFMA, Accessed Jan 20, 2020, https://www.hfma.org/topics/hfm/2018/september/61778.html Read more

What the HETS transition means to you

Ready or not, a change is coming to your Medicare eligibility check process.

The Centers for Medicare & Medicaid Services (CMS) has officially announced the deadline for hospital, home healthcare, hospice and skilled nursing (Part A) eligibility inquiries to transition to a new platform.

On February 1, you must bid farewell to the Common Working File (CWF) and embrace the HIPAA Eligibility Transaction System (HETS) for eligibility verification.

The future for CWF and HETS

Though all eligibility inquiries will transition to HETS, CWF will still exist for claims management functions (entry/status/summary) and other transactions.

For eligibility purposes, the main difference users will notice is that HETS requires slightly different input information and returns more targeted results than CWF. Other differences include once-daily information updates and a limit of 30 eligibility requests per day.

Next steps

The most important thing to do prior to the deadline is prepare. If you’re already using HETS, there’s nothing you need to do. If you’re currently using both systems, you should start using HETS exclusively.

ABILITY® customers who currently use an application for eligibility verification can expect a seamless transition with no disruption to business as usual. All of our applications with integrated eligibility components are currently HETS-ready/connected. What that means for you is that February 1 will bring no changes or surprises.

To learn more about how ABILITY can provide a stress-free switch, request a demo today.

For additional information about the transition to HETS, visit the CMS announcement page.

New NPI Verification Process for Eligibility Inquiries Set to Begin

After years of delays, the process for verifying eligibility will soon change for healthcare providers throughout the country. CMS is migrating hospital, home healthcare, hospice and skilled nursing (Part A) eligibility inquiries from the Common Working File system (CWF) to the HIPAA Eligibility Transaction System (HETS) in the fall. After that time, providers will no longer be able to access CWF to verify eligibility. The transition will not impact access to the CWF for claims management.

Healthcare providers who want to verify Part A Medicare eligibility benefits will be required to use a National Provider Identifier (NPI) that is registered in the Medicare Provider Enrollment and Chain/Ownership System (PECOS) database. As part of the eligibility process, these eligibility applications will verify that the NPI used on the inquiry is present in the Medicare PECOS database.

What to expect

Whether you work in an acute or post-acute setting, the change means that inquiries made with NPIs NOT present in the Medicare PECOS database will fail to return Medicare eligibility data. To avoid verification disruption, it’s critical that you review the PECOS status for any NPIs currently used by your organization. If your NPIs are not currently registered with PECOS, update that information accordingly. Additional information on PECOS and how to register your NPI can be found here.

What if your organization uses HETS, or uses both HETS and CWF for eligibility verification? If you’re already using HETS, there’s nothing you need to do. If you’re currently using both systems, you should start using HETS exclusively.

How we got here

CMS first signaled plans to discontinue eligibility checks through CWF in December 2012, announcing that HETS would be the single source for this data. After receiving feedback about – and later resolving – the differences in data returned from the two systems and the one-year limit to HETS historical searches, CMS is now moving forward with the transition to one system.

ABILITY® has you covered

As was the case in previous CMS transitions, ABILITY is well prepared to make sure healthcare providers experience no disruption.

For ABILITY EASE® Medicare, ABILITY CHOICE® Medicare Eligibility and ABILITY COMPLETE® customers, the transition is a non-event. Providers can continue to verify eligibility in CWF until CMS requires the move to HETS. From there, ABILITY will manage the transition to HETS to ensure a seamless transition for the customer. It’s one of the many ways ABILITY helps simplify complexity for its customers.

eligibility verification

3 Ways to Make Your Eligibility Verification Process More Efficient

Eligibility verification is the first step in the revenue cycle – and arguably, the most important. Without an efficient verification process, it’s hard to communicate with payers and determine payer/patient payment responsibilities. These challenges can increase the number of mistakes made during claims submissions. They may also add time to your average A/R days or lower the revenue you’re able to capture each month.

If you’re familiar with the costs of patient eligibility challenges, try a different verification approach. Here are three ways you can increase eligibility verification efficiency.

1. Take advantage of real-time eligibility verification opportunities

Verifying patient eligibility via individual payer portals or over the phone is not ideal. These processes are extremely time-consuming. They delay patient access to treatment and often cause stress for front-of-house staff.

A real-time verification process, available through a single eligibility portal, is much more efficient. It simplifies communication with payers and provides quick eligibility answers, meaning your team can verify coverage in a matter of seconds, not hours or days.

With the right tool, you can enjoy this fast, highly efficient workflow to communicate with Medicare, Medicaid and private payers.

2. Save time with saved patient data  

Real-time verification is just one of the many workflow benefits that an eligibility portal like ABILITY COMPLETE® can provide. Additional functions may include storage of eligibility transaction history and the ability to resend prior eligibility requests.

Having access to this data offers significant time-saving opportunities. It gives your team all the information they need to quickly verify patient eligibility every single time a patient comes in. This replaces the slow, tedious task of asking patients to fill out forms and having staff manually input their information. It results in increased patient satisfaction and decreases the likelihood of sending claims with inaccurate information.

3. Educate patients and collect payments before treatment

To achieve a high level of efficiency throughout the revenue cycle, engage patients early on. Educate them about their coverage and their payment responsibilities. Break down the costs of treatment for both long-term and one-time services, and collect each payment at the time of service.

Providing patients with an understanding of their payment responsibilities up front helps your business avoid possible loss of payments. It reduces the risk of inadequate benefit challenges after treatment has started, and it increases the likelihood that a patient completes their long-term care plan.

Innovative processes combined with attentive patient care can transform your RCM performance. In terms of eligibility verification alone, the best way to improve efficiency is to focus on working faster while producing more accurate results.