MEDICARE DSH
DSHRIP | Medicare Disproportionate Share (DSH) Revenue Improvement Program
MBI ID FINDER
Medicare Beneficiary ID Finder Service
As of 1/1/2020, CMS requires the Medicare Beneficiary Identifier (MBI) in all Medicare transactions. The MBI is a random number not based on SSN making it impossible to derive. Also, CMS has significantly tightened up search criteria and has reduced search capabilities to find the MBI.
If not captured at registration, it is very difficult to resolve a missing or incorrect MBI. GDS has developed special proprietary methods to find MBIs and other demographic data needed to match the CWF for Medicare beneficiaries to allow for proper Medicare billing.
Providers now struggle with billing Medicare due to the MBI transition. Additionally, providers now also struggle with shadow-billing Medicare for Medicare Advantage patients due to the increased effort needed to obtain the MBI. CMS does not provide easy ways on the backend for providers to capture the MBI and other demographic data needed for billing.
During a recent engagement with a large provider, GDS discovered over 400 Medicare claims left unbilled due to an inability to identify the proper MBI for the claims and found over 3,000 Medicare Advantage claims not shadow-billed for the same reasons.
In this case, GDS was able to identify these claims for this provider allowing them to bill Medicare for the Part A and Part C patients and thus get paid for the Part A patients and receive IME payments through claims and the full GME and NAHE reimbursement through the Medicare Cost Report for the Part C days.
Do you understand your institution’s financial exposure from the switch to MBI’s?
Through the GDS diagnostic review, GDS can scope the size of this issue for your providers and allow you to plug these holes capturing additional Medicare payments and Reimbursements. GDS believes that you could increase Medicare revenues annually by 1% to 3% using the GDS MBI Resolution service.
Our complimentary diagnostic review is a very simple process and will not require much time or effort by your staff.
