Article Detail - JA DME

Recently some DME suppliers have noticed an increase in beneficiaries who previously were assigned an MBI, being sent a new Medicare card with a different MBI. There could be various reasons for this; some of which are explained below.

• Data breach: Data breaches may occur at the Medicare Administrative Contractor, including when using third-party software, even though these contractors are to follow strict security guidelines. Depending on the circumstances of the breach, new Medicare numbers may be assigned to replace compromised numbers due to the data breach. In early September, 2024 CMS notified beneficiaries of such a breach at a MAC and that new Medicare cards would be issued in two weeks.
• Fraudulent Claims: In early 2023, there was a fraud scheme where 15 suppliers were billing catheters for patients where CMS determined that people with Medicare did not receive catheters from these suppliers, physicians did not order these supplies, and the supplies were not needed. CMS replaced hundreds of thousands of Medicare Beneficiary Identifiers (MBIs) that were used to file the suspicious claims. CMS changed the MBIs of the most at-risk people with Medicare and completed changing all impacted MBIs in March 2024.
• Medicare Card Was Stolen or Lost and MBI was Compromised: If a beneficiary feels that someone is using or has obtained their MBI number or card, they may request that a new MBI be issued.

Importance of Verification for DME Suppliers

In light of the above, it is essential for DME suppliers to verify beneficiaries' Medicare cards and MBI numbers. Accurate and up-to-date information is critical to prevent interruptions in the reimbursement process for claims. Here are key actions suppliers should take:

1. Verify Beneficiary Information: Regularly check and update beneficiary MBI numbers in your systems. Ask to see the beneficiary’s card or for them to verify the MBI or ask them if their Medicare insurance has changed on a regular basis to prompt them to report changes to their MBI. These steps are vital to ensure that your records reflect the latest information.
2. Utilize the NMP MBI Lookup Tool: If a claim denial occurs with Reason Code 16 and Remark Codes MA27 and N382, use the NMP MBI Lookup Tool to confirm the beneficiary's MBI.
   • Reason Code 16: Claim/service lacks information or contains submission/billing errors.
   • Remark Code MA27: Missing, incomplete, or invalid entitlement number or name
   • Remark Code N382: Missing, incomplete, or invalid patient identifier.
3. Follow Denial Code Resolution Guidelines: In the event of receiving a denial, consult the Denial Code Resolution tool for instructions on how to resolve these.