April XX, 2017
The Honorable Seema Verma
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
Hubert H. Humphrey Building, Room 445–G
200 Independence Avenue, SW
Washington, DC 20201
Re: Social Security Number Removal Initiative
Dear Administrator Verma:
The undersigned organizations are writing to express concern over the Centers for Medicare & Medicaid Services’ (CMS) planned enactment of the Social Security Number Removal Initiative (SSNRI). As explained below, this initiative has the potential to significantly disrupt patient care and physician payment. Accordingly, we recommend that CMS pursue this change through the traditional notice and comment rulemaking process so that valuable industry feedback may be considered. We further ask that CMS develop a mechanism for providers to quickly and securely access Medicare beneficiary identification numbers to avoid disruptions in access to care.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 included a provision requiring CMS to remove the Social Security Number (SSN) from Medicare cards due to concerns of identity theft. The process CMS has developed to implement this requirement is referred to as the SSNRI. CMS currently uses a Health Insurance Claim Number (HICN), based on an individual’s SSN, as a patient’s Medicare beneficiary identification number. To implement the SSNRI, CMS will create new Medicare Beneficiary Identifiers (MBIs), first for the 60 million active Medicare beneficiaries and then for 90 million deceased beneficiaries, to replace the HICN on beneficiary identification cards.
Starting in January 2018, CMS plans to conduct outreach and education to beneficiaries to alert them of the transition from the HICN to the MBI. New identification cards displaying the MBI will be sent to beneficiaries in phases over a twelve-month period beginning April 1, 2018. CMS, however, does not plan to disclose the details of how the cards will be sent (e.g., alphabetically, by state or region, etc.). While CMS will accept both HICNs and MBIs in administrative transactions during the transition period (April 1, 2018 – December 31, 2019), providers’ systems must be ready to accept the MBI by April 2018 and must exclusively use the MBI starting January 1, 2020. CMS will provide MBIs in remittance advice for part of the transition period (beginning in October 2018), but there will be no mechanism for providers to obtain a patient’s MBI after January 1, 2020 – even if a patient’s first appointment with a particular provider after being assigned an MBI occurs after the transition period. This scenario is particularly likely for patients receiving new cards towards the end of the issuing cycle and for provider types, such as specialists, from whom the patient may not seek frequent care.
As explained in more detail below, we are concerned about a provider’s inability to access a patient’s MBI both during and following the transition. If a patient does not bring his or her MBI to his or her appointment, significant delays in patient care or provider reimbursement could result due to the lack of a mechanism for the provider to look-up the patient’s MBI.
While we understand the importance of protecting Medicare beneficiaries from identify theft by replacing SSNs with new MBIs on Medicare identification cards, we have concerns about patient and physician awareness of this change and backup plans to mitigate potential problems. In a September 23, 2016 letter responding to providers’ request for traditional rulemaking concerning the SSNRI, CMS characterized the majority of needed changes as being “operational in nature”, making a regulatory review and comment process unnecessary. We respectfully note that this change will impact all Medicare beneficiaries and that all systems and business processes will need to be able to accept and process the new MBI. We therefore urge CMS to work with stakeholders to avoid significant problems and again recommend that CMS instead pursue this change through the traditional notice and comment rulemaking process so that valuable industry feedback on SSNRI implementation may be obtained and considered.
Furthermore, multiple provider groups have expressed overwhelming concern regarding the lack of a contingency system that will allow medical practices to obtain the MBI for a patient who arrives at an appointment without a new Medicare card. This lack of a provider look-up system may strain a practice’s ability to conduct administrative transactions and delay patient care in the event that a patient does not present his or her card at the time of service. In addition, family members managing the patient’s care and affairs may not have access to the new card. Providers have offered a range of potential solutions—including look-up databases, providing MBIs in electronic eligibility responses, and secure phone systems—to both protect sensitive MBI data and allow practices to access the information needed to continue providing timely care to Medicare patients. An SSNRI transition plan that is totally dependent upon patient presentation of new Medicare cards to providers will result in delayed treatment and claim payment.
We have the following additional concerns about the SSNRI transition process:
In an age of increased identity theft and fraud, the Medicare patient population deserves the improved security that will be achieved with the SSNRI. This protection should not, however, come at the expense of prompt patient care or provider payment. We urge CMS to consider adjusting the implementation of the SSNRI as outlined above to protect care access for our nation’s seniors. We appreciate your attention to this matter.