Home Health and Hospice Billing When a New Medicare Beneficiary Identifier Is Assigned

A patient’s Medicare Beneficiary Identifier (MBI) number is required on all home health and hospice billing submitted to Medicare. There are times a home health admission or hospice election has started, and the patient receives a new MBI. When an MBI is changing, Medicare mails the beneficiary’s Medicare card with the new MBI 30 days prior to the effective date of the MBI change. 

Home Health Notice of Admissions (NOAs), Hospice Notice of Elections (NOEs) and claims are required to be submitted with the current MBI or they will be returned to the provider for correction. With the five-day requirement to submit NOAs and NOEs, it is important to verify the MBI is valid. Invalid MBIs submitted on NOAs or NOEs may cause them to be late and receive a late submission penalty.

How Can a Provider Verify an MBI is Current?
It is important to verify patient eligibility prior to admission and prior to billing. Submitting the appropriate MBI based on the effective date of issuance and the dates of service being billed will help avoid claim edits and ensure proper billing and efficient processing.

Palmetto GBA’s eServices offers two tools to verify a beneficiary’s MBI is current.

1. The “MBI End Date” field in the Eligibility tab

a. If there is a date present in the field, the MBI is not valid for submissions after that date 

i. To retrieve all eligibility information available, you must enter a valid date range on the inquiry page. Date ranges may not exceed 24 months at a time. The entered date range may include a future date (up to (4) months in the future) to insure the MBI is not pending an upcoming change. 

ii. The example below shows a termination date of 06/05/2022. To get this response, the entered date range must overlap the termination date. If the date range does not overlap, no beneficiary eligibility information will return. 

2. MBI Lookup

a. This lookup only provides the current MBI

b. When you click on the MBI Lookup tab, you will be presented with the MBI Lookup screen. The user should enter a beneficiary’s information into the fields and use the Submit Inquiry button. To protect the privacy of beneficiary data, all fields entered, including optional fields, must match the beneficiary’s data; otherwise, MBI data will not be returned.
 

Home Health Billing Notes When the MBI has Changed
Home health agencies (HHAs) have encountered a couple different scenarios when a new MBI is issued.

1. The NOA processed under the old MBI. The NOA does not need to be canceled and resubmitted under the new MBI. The HHA needs to enter the new MBI on all future billing on or after the effective date of the new MBI. The HHA must also update the OASIS, if needed, to ensure the MBI on the OASIS and claim match. 
    
2. The admission period has started and the NOA and period of care claim(s) processed under the old MBI. Everything processed in the Medicare claims system remains — there is no need to cancel the claim(s) or NOA in order to resubmit under the new MBI. All billing on or after the effective date of the new MBI must be submitted with the new MBI. HHAs must ensure the MBI on the OASIS matches the new MBI billed on the claims.
    
3. Claim adjustments must use the current MBI, even if the original claim was submitted with an old MBI
    

Hospice Billing Notes When the MBI has Changed
Hospice scenarios when a new MBI is issued.

1. The NOE processed under the old MBI. The NOE does not need to be canceled and resubmitted under the new MBI. The hospice needs to enter the new MBI on all future billing on or after the effective date of the new MBI. 
2. The NOE and monthly claim(s) processed under the old MBI. Everything processed in the Medicare claims system remains — there is no need to cancel the claim(s) or NOE to resubmit them under the new MBI. All billing on or after the effective date of the new MBI must be submitted with the new MBI. 
3. Claim adjustments must use the current MBI, even if the original claim was submitted with an old MBI
    

Late NOAs and NOEs Due to MBI Changes

Effective for NOAs on January 1, 2024, and May 15, 2023, for NOEs, A/B MAC MACs will not grant exceptions based on MBI changes that were accessible to the HHA or hospice more than two weeks prior to the admission date. Since current beneficiary identifier information is available to HHAs and hospices in eServices’ MBI Lookup tab or other MAC’s provider portal, only changes that occur shortly before the admission are beyond the HHA or hospice’s control.

Resources

• eServices User Manual (PDF)
• Medicare Beneficiary Identifiers (MBIs)
• 40.1 — Notice of Admission (NOA), HH Medicare Claims Processing Manual (PDF)
• 20.1.1 — Notice of Election (NOE), Hospice Medicare Claims Processing Manual (PDF)