beginning of the year, the healthcare industry moved away
from Medicare identifiers based on Social Security Numbers (SSNs), in favor of
more secure Medicare
Beneficiary Identifiers (MBIs). As with
any large-scale change program, the shift was unlikely to be completely clear
sailing. But with the coronavirus pandemic landing shortly after the 21-month transition
period was due to conclude, the switchover has been rougher than expected.
Care providers are discovering newly eligible Medicare
beneficiaries who haven’t yet received their card, while existing beneficiaries
have misplaced theirs. Without
a valid MBI number, patients risk delayed access to care, while the admin
process to sort it out can be stressful, especially for already-vulnerable
For providers, the
extra work and delayed reimbursements are particularly unwelcome when COVID-19
is already putting pressure on services and squeezing revenue. Unprecedented intake
conditions where staff and patients are trying to limit face-to-face contact
makes it difficult to complete the usual coverage checks. As a result,
providers are missing revenue opportunities they cannot afford, while incurring
additional downstream costs when collections are delayed.
clients are optimizing Coverage Discovery to speed things up.
Case study: how one healthcare provider is
finding missing Medicare coverage faster
For example, the southeast division of a
national health care system, with 1700+ beds and $1.6B in revenue, needed
better ways to find MBIs when Health Insurance Claim Numbers (HICNs) were
phased out. Assisting Medicare patients with tracking down their MBIs was
time-consuming and error-prone. They came to Experian Health to find a more
efficient way to check Medicare coverage.
Jason Considine, Experian Health’s Senior Vice
President for Patient Collections and Engagement, says:
“We knew we could help because we already had
Medicare coverage history through our historical repository. As a test, we were
given a control set of known Medicare patients without MBIs, and were charged
with finding those patients’ MBIs and Medicare coverage.”
Experian Health’s Coverage
Discovery tool was used to batch-process the control
set. This took less than a day, as the tool scans more than one million
accounts daily, using historical and demographic data, synthesized with
multiple proprietary data sources, to find unknown or forgotten coverage. In
this case, the resulting data was collated via batch files, but could be
integrated with other coverage and collections tools, such as eCareNext,
which automates the more repetitive and hands-on pre-registration tasks.
Coverage Discovery found 60% of the Medicare
coverages with MBIs, plus additional coverages. This enabled the provider to
file claims that would otherwise have been nearly impossible and very time
The provider’s next steps will be to integrate
Coverage Discovery with eCareNext, and roll it out to more of sites in the
Could Coverage Discovery help your
organization find missing MBIs?
Capturing better insights into productivity,
financial results, and staff workflows is always valuable. But in the current
crisis, tool that maximize reimbursement and automating the tasks that take up
staff time is essential.
Through our historical data repository,
Experian Health’s Coverage
Discovery already contains many patient MBIs – and it’s
continually updated. We can help you search for Medicare coverage and make sure
your clients find their MBIs, easing pressure off your revenue cycle management
teams during this extremely challenging time.
Request a review of
Coverage Discovery and improve your coverage and collections processes.