Patient access departments need revamped processes to prepare for new Medicare ID cards without Social Security numbers. It is important to train staff on the following items:

  • Where to place the number in records;
  • How to explain the change to patients;
  • How to use scripting well in advance of the change.

Concern over identity theft has made patients understandably reluctant to give their Social Security number to registrars, especially over the phone.

“This greatly impacts the ability to correctly identify patients during scheduling and pre-registration processing,” says Sandra J. Wolfskill, FHFMA, director of healthcare finance policy at the Healthcare Finance Management Association.

As of April 2018, the Centers for Medicare & Medicaid Services will start mailing new cards to people with Medicare benefits. The cards will have a new unique, randomly assigned number called a Medicare Beneficiary Identifier (MBI), to replace the existing Social Security-based Health Insurance Claim Number (HICN). All Medicare cards will be replaced by April 2019.

“It is going to be mission critical that all provider systems that currently use or record the Social Security number have the ability to capture and store the new number,” says Wolfskill.

It’s not enough to simply replace the Social Security number with the MBI. “Both the social security number currently in the patient’s record, as well as the new MBI, should be captured and stored,” Wolfskill explains.

Training Will Be Essential

Patient access staff need to understand the new MBI system, as well as where to place the number in the various records. “Staff also need to be prepared to explain this identifier change to patients,” says Wolfskill. Patient access staff will need to do these three things:

  1. Ask the beneficiary if he or she has received a new identification card from Medicare recently.
  2. Describe the card. “Beneficiaries will not recognize the new card as an ‘MBI.’ So eliminate initials and acronyms from the conversation,” says Wolfskill.
  3. Explain that the new card is designed to protect their privacy.

“It is important to remember that this is a phased-in change. Some beneficiaries will not have a new card for a number of months,” says Wolfskill.

Revenue cycle leadership will need to plan how the use of the Medicare number on claims will migrate to using the new MBI number system.

“Make sure staff understand why the identification numbers are being changed,” emphasizes Wolfskill. “Caution against the use of initials or acronyms!”

An equally important step: Identify all systems that need modification. “If you are using a bolt-on tool for insurance verification, for example, is your vendor making the appropriate changes to that system?” asks Wolfskill.

The best approach is to get staff involved in creating scripting for this change. “The final script needs to sound natural and be easily understood by the beneficiaries,” says Wolfskill. Giving staff an opportunity to practice the new scripting in a classroom or meeting well before the initial implementation begins is ideal.

Patient access departments will need to make these other changes, says Wolfskill:

1. Quality data edits will need to be modified.

“At the end of the 21-month implementation schedule, every account needs to be validated for the new MBI,” says Wolfskill.

2. Patient access leadership will need to review all systems, written and electronic forms, and correspondence to ensure that the new MBI number replaces the patient’s current Medicare number. 

“Obviously, the EHR will require modification to retain the old HICN, but also capture the new MBI as that information is collected,” says Wolfskill.

3. Any subsystem, such as Advance Beneficiary Notice production, also will need to be modified to capture and print the new number. 

Likewise, supplemental payers currently using the HICN as a patient identifier will need to change their systems to accept the new MBI.

“Identifying those payers and testing claims with them is also important,” adds Wolfskill.


  • Sandra J. Wolfskill, FHFMA, Director, Healthcare Finance Policy/Revenue Cycle MAP, Healthcare Finance Management Association, Westchester, IL. Phone: (708) 531-9600. Fax: (708) 531-0032. Email: swolfskill@hfma.org.