As the CMS works to remove Social Security numbers from millions of Medicare ID cards, providers are calling on the agency to increase physician outreach efforts to alert them how billing under the program may change.
During a Wednesday meeting, HHS' Advisory Panel on Outreach and Education told the CMS that it needs to ensure that providers know they must update their electronic health record systems to accept new Medicare ID numbers created to curb fraud and abuse. The panel of experts made up of providers, health plans and healthy policy experts advises the agency on outreach strategies.
Since the beginning of the Medicare program, Social Security numbers have been used as the beneficiary identifier for administering services. But MACRA mandated Social Security numbers be removed from Medicare cards because of identity theft and fraud risks.
Per the law, the CMS will issue Medicare cards with a new ID number to approximately 60 million beneficiaries by April 2019. The new cards will begin being shipped out in April 2018, and the CMS is developing an outreach effort to notify the public about the change.
But providers said Wednesday that the CMS should reach out to providers in the coming weeks to alert them about how the ID card changes could affect their billing privileges.
Doctors will need to update their EHR systems to accept the new ID numbers or risk losing their ability to bill Medicare once the old ID numbers are phased out in 2020.
“Do doctors know they'll need to have these changes in place by April 2018?” Dr. Dale Blasier, an orthopedic surgeon at Arkansas Children's Hospital and panel member, asked during the meeting.
Panel members also suggested the CMS develop a web portal that would allow providers to look up patients' new ID numbers if they lose their card or fail to bring them to appointments. Without that safeguard, patients could lose out on care after 2020 when providers are no longer able to bill under the old Social Security-based ID numbers.
“If a patient doesn't have the new number, and the old number doesn't work, the last thing you want is to deny services,” said Dr. Alvia Siddiqi, a panel member and medical director for Advocate Physician Partners, a care-management collaboration with more than 3,000 physicians.
A CMS staffer at the event said the agency has no plans to address that issue, but she would take the suggestion back to the implementation team.
The Medical Group Management Association also raised concern about access to the new ID numbers to the CMS in a August 2016 notice to its members.
Access to the new ID numbers will be critical to ensure medical practices have the ability to bill for patients who come in after Jan. 1, 2020, but don't have their new ID cards, according to the trade group, which represents 385,000 physicians practices.
It is unclear how prevalent Medicare ID number fraud is. In fiscal 2016, the Medicare improper payment rate was 10.33% or $38.61 billion. An improper payment can occur when funds go to the wrong recipient, the right recipient receives the incorrect amount of funds, documentation is not available to support a payment or the recipient uses funds in an improper manner. The tally also includes actual fraudulent claims.