ophthalmologist with medicare patient2020 brought some changes to ophthalmology billing. This is the third in our 3-part series on the CPT changes you need to be aware of.

UPDATE: Medicare no longer uses Social Security Numbers (SSNs) as patient identifiers.

The Details

Medicare cards now use a Medical Beneficiary Identifier (MBI) to identify patients. This 11 character alpha-numeric code will be used to bill Medicare. Learn more about MBIs here.

What It Means for Billing

With a few exceptions, not using MBIs on Medicare claims after January 1, 2020 will result in:

  • Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber)
  • Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”.

Billing #ProTip

It’s critical to get current insurance information from patients at each visit. Not doing so can result in unpaid, denied claims which affects cash flow and your A/R. Make sure your practice has a process in place to obtain insurance information from patients.

Coding changes have you puzzled?
The EyeMed Management team stays up to date on coding changes and best practices. Learn how our team can help you avoid costly errors and see increased revenues by contacting us today.

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