Tuesday, July 31, 2018

Are You Ready for the New Medicare Cards?

Medicare is rolling out new cards and MBI numbers, and Patient Access professionals must be prepared to answer questions
Check out the NAHAM webinar 'Are You Ready for the New Medicare Cards' for tips and tricks for your organization.  
The Centers for Medicare and Medicaid Services (CMS) began issuing new Medicare cards in April 2018. Medicare beneficiaries will receive their cards in the mail between April 1, 2018 and April 1, 2019. The new Medicare cards are necessary because the 2015 law, the Medicare Access and CHIP Reauthorization Act, requires CMS to remove Social Security numbers from Medicare cards by April 2019. The move is seen as a way to guard against identity theft; specifically, it is seen as a way to better protect private healthcare and financial information as well as federal healthcare benefits and service payments.
Replacing the Social Security number (the SSN-based Health Insurance Claim Number, or HICN) will be a new Medicare Beneficiary Identifier (MBI). Each beneficiary will be assigned a unique MBI, and it will appear on the new Medicare cards for existing beneficiaries and all new enrollees going forward.
A transition period began April 1, 2018 and will run through December 31, 2019; during this period, providers may use either the SSN-based HICN or the new MBI for purposes of data exchange. Starting January 1, 2020, providers will be required to submit claims using MBIs, no matter the date of service. CMS has developed a secure look-up tool for providers to find the new number at the point-of-service, and when a provider checks a beneficiary’s eligibility, the CMS HIPPA Eligibility Transaction System (HETS) will return a message indicating if CMS has mailed a new card to the beneficiary. CMS has also issued some detailed information on appeals, adjustments and span-date claims.
The new MBI will clearly look different from the Social Security number and two-character Beneficiary Identification Code on the old cards. The MBI will be 11 characters in length, solely made up of numbers and uppercase letters (no special characters). Each MBI is unique and randomly generated, and the characters and sequence are “non-intelligent,” meaning they don’t have any hidden or special meaning. There is a sequence protocol in that certain positions of the 11-character MBI will only have numeric or alphabetic characters, and two positions may have either numbers or letters. Positions 2, 5, 8 and 9 will always be alphabetic. See the CMS webpage: Understanding the Medicare Beneficiary Identifier (MBI) Format [insert link: https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf], for more information.
The new card will have the beneficiary name, the new Medicare Beneficiary Identifier, coverage and coverage dates. These element names will be in both English and Spanish. The gender and signature line found on the old Medicare card will not appear on the new card. All cards will be printed on white paper.
Once issued, beneficiaries and providers may begin using the new MBI immediately. For more information, see the CMS webpage: What do the new Medicare cards mean for partners and employers? [insert link: https://www.cms.gov/Medicare/New-Medicare-Card/Partners-and-Employers/Partners-and-employers.html]
Mailings will include the new card and a letter with instructions for the beneficiary. Distribution of cards will be random, so there is no relationship between mailing and geographic regions.
A September 2017 CMS survey found “extremely low awareness” of the planned changes among beneficiaries. When told of the changes, the survey found most see this as a positive change and had no major concerns. CMS is including education during its 2017 open enrollment and will be sending providers information on how they can help during the first quarter of 2018. CMS is also planning an aggressive social media campaign.

CMS advises providers to check with their solution vendors to make sure they have received instructions about the secure provider look-up tool, and that they are aware of all system changes. CMS also asks providers to display posters and place “tear-off” pads in offices and waiting rooms — all of which may be found and ordered online. Providers should also periodically check the Medicare Learning Network [insert link: https://www.cms.gov/medicare/new-medicare-card/nmc-home.html] for more information.  
Providers will be involved in educating patients, and CMS provides a number of resources to use when talking to patients about their new Medicare cards. Here are some of the points CMS emphasizes in these materials to tell patients:
1.      Right now patients should make sure their mailing addresses are up to date with the Social Security Administration. CMS will use that address to send a new Medicare card. They can check and update online through your “my Social Security” account [insert link: https://www.ssa.gov/myaccount/] or by phone 1-800-772-1213 (TTY: 1-800-325-0778).
2.      Patients may not get the new Medicare card right away. Mailing out new cards to all beneficiaries will take time. They will only need to call Medicare if they don’t receive their card by April 2019.
3.      Patients should be wary of anyone who contacts them about their new Medicare cards. Medicare will never ask someone to give them personal or private information for a new card or number. CMS is planning a “Guard Your Card” campaign starting in late summer of 2018.
4.      Even though they are getting a new Medicare card and number, a patient’s Social Security number remains the same. They just won’t be using it relative to their Medicare benefits.
5.      Once they receive a new Medicare card, patients should check the name and other information to make sure it is correct. The new card will not change their current coverage or benefits. If everything is in order, they should destroy the old card and start using their new card.
6.      Patients must remember to bring their new Medicare card. Doctors and other healthcare providers will ask for it when they need care. If they forget their new card, doctors or other healthcare providers may be able to look it up online.
7.      Patients should guard their new card and new identification number (the MBI) just as they did their old card and Social Security number. They should only give their card and MBI to doctors, pharmacists and other healthcare providers, their insurers or people they trust to work with Medicare on their behalf.
8.      Their new card will be paper. It will be easier for providers to use and copy and they can print your own replacement card if need be.
Is Your Address Up to Date?
This should become the most common question you ask Medicare beneficiaries. Not the first thing you’d think of when talking to patients about the new Medicare cards that will start appearing this spring, but providers will play an important role in educating patients about the new cards and the new Medicare Beneficiary Identifiers. One important thing for the Medicare beneficiary to do is to make sure their mailing address is up-to-date with the Social Security Administration because CMS will use the address they have on file with Social Security; new cards started mailing out on April 1, 2018 and will continue through April 1, 2019.
Be Vigilant Against Identity Theft
Beneficiaries should know not to share their new Medicare number with anyone other than their healthcare providers, their insurers or trusted healthcare advocates with Medicare. Medicare will never ask someone to give them personal or private information just so they can get their new card or number. Don’t fall for phone scams!

Monday, July 2, 2018

The Joint Commission issues Quick Safety 42: Identifying human trafficking victims

 The Joint Commission issued a safety alert on identifying human trafficking victims on June 18 (see Quick Safety 42: Identifying human trafficking victims). The first paragraph is an attention-getter:

The United States is one of the largest markets and destinations for human trafficking victims in the world. If staff at your health care organization have not yet encountered a human trafficking victim, very likely they will. Knowing how to identify victims of human trafficking, when to involve law enforcement, and what community resources are available to help the individual is important information for all health care professionals.

The alert notes over 40,000 reports of human trafficking in the U.S. over the 10-year period 2007-2017, with the largest number of reports coming from California, Texas, Florida, Ohio and New York, and asserts that “Human trafficking is the fastest growing criminal industry in the world and is the second-largest source of income for organized crime.”

Part of the problem is one of recognition and the challenge seems to be both identifying and knowing how best to help victims.  Most victims or their families have been threatened with harm if they reveal their exploitation, in some cases the victim may not realize his or her rights in the host country, and often times the victim has bonded with his or her exploiter, a condition known as “trauma bonding”.  In addition to fear of physical harm, victims also keep silent due to shame or fear of being humiliated.

The alert provides a technical definition of human trafficking, citing the United Nations Protocol to Prevent and Suppress and Punish Trafficking in Persons, Especially Women and Children and a U.S. law, the Victims of Trafficking and Violence Prevention Act.  But perhaps more helpful, it identifies “at-risk” or the most vulnerable populations for human trafficking which include children involved in foster care, runaway and homeless youth, Native Americans, LGBTQ individuals, undocumented immigrants, among others.  Also particularly useful, the alert highlights health care problems most that may trigger a cause for concern.

So to repeat the stance of The Joint Commission: “Knowing how to identify victims of human trafficking, when to involve law enforcement and what community resources are available to help the individual is important information for all health care professionals.”  The alert provides some metrics for recognizing signs of human trafficking and guidance for when human trafficking is suspected.

In terms of recognizing signs of human trafficking, there are poor mental health or abnormal behavior (such as appearing fearful, avoiding eye contact and refusing treatment) and poor physical health (such as appearing malnourished or signs of physical abuse).  Other signs include not being in control of personal identification, not be allowed to speak for themselves, and inconsistencies in his or her story).

Regarding when human trafficking is suspected, The Joint Commission notes that every situation will be unique and that “it is important to use a victim-centered response.”  While not every victim will be ready to seek help, the Commission notes that “if a victim is a minor (under 18 years of age), the provider is legally obligated to contact Child Protective Services.”  Responses will also depend on whether human trafficking is suspected or if the patient has disclosed that he or she has been trafficked.  The Joint Commission offers options for each of these situations.  For example, the alert notes that if the patient indicates he or she has been trafficked “in situations of immediate, life-threatening  danger,” the provider should follow “institutional policies for reporting to law enforcement.”  Other “safety actions” recommended include providing the patient with options for services, reporting and resources and if your organization has a social worker – “utilize them”. 

What role could Patient Access personnel be expected to play?  Most likely Patient Access would become aware in the Emergency Department – so personnel could be exposed to the common signs and at-risk groups identified in The Joint Commission’s alert to increase general awareness.  Institutional protocols would govern who in the organization would be engaged once human trafficking is suspected or confirmed.  Patient Access personnel should know who to contact within the hospital so appropriate action can be taken. 

As Martin Muratore, CHAM stated, “The role would be interdisciplinary. If and when Patient Access became aware, they would need to ensure that proper notifications were made.  As with all crime and for victims of abuse, any person who has contact with the patient should immediately report to police and social services or the social work department of the organization.”  Muratore notes that in most cases it will be an actual health care provider in the clinical situation who first becomes aware of the abuse or trafficking. Brenda Sauer, RN, MA, CHAM, FHAM agrees: “The Patient Access professional should be able to identify and then report through their usual channels if they suspect abuse.  This is usually  telling a clinician or social worker of their suspicions.”  And Nancy Farrington, CHAM, FHAM confirms that it is most likely going to be a clinician who is in the best position to detect abuse, but that Emergency Department Patient Access may be in a position to notice signs and that reporting to clinicians or social workers is the appropriate response. Patient Access staff may become aware of these situations, especially in the Emergency Department. I would not expect Patient Access staff to report suspicions to outside agencies but rather to follow internal protocols to have providers, clinicians, social workers, etc. make an assessment and take action.”

The Joint Commission’s alert is worth a read and provides some actionable and educational material for staff.  Awareness and response will clearly involve multiple disciplines in the organization and emphasizing internal protocols in addition to the information provided in the alert is a good place to start.