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We’re moving!

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Our office will be closed on Friday 8/4 for the move.

We will be open for business as usual on Monday 8/7.


Lost Revenue from Claim Denials

What are the best ways to tackle it now and avoid it happening in the future?

Claim denials cause significant loss of revenue for nursing care facilities. If only 5% of medical claims were denied – which is rarely the case – the revenue loss would be substantial.

Case in point: suppose a nursing home is submitting 100 medical claims per day to insurance providers. With a reimbursement rate of approximately $100 per claim, that brings the facility close to $10,000 of revenue per day. Claims get denied around 15% of the time. But to effectively show this, let’s look at an average of 5%. That means five claims would be denied every day totaling $500 of revenue loss per day. Looking through a financially strategic lens, that’s a loss of $120,000 a year. Ouch!

Therefore it is crucial to tackle claim denials before the re-submission deadline and to create a strategy to avoid it happening in the future.


Here are a few steps to do this effectively:


Step 1: Point your staff in the right direction.

Provide the staff with the necessary motivation so that they can help with the process. They should be shown the actual revenue loss that occurred or that is ongoing due to claim denials. This will vary from facility to facility, so it’s important to research and provide accuracy.

Step 2: Find the reason for each claim denial.

This is important as the reasons for denial can vary.

Ways to go about doing this:

  • Analyze trends in billing data that may cause denials
  • Is there a spelling error or is the inputted information altogether wrong?

Check resident, provider, and insurance provider information for accuracy.

Examples of this can be name, DOB, sex, insurance ID number, treatment received, relevant medical codes, provider ID, facility mailing address, contact name, policy number, address of insurance provider, insurance contact info, etc.

When there is a better understanding of what is causing claims to be denied, it’s appropriate to move to the next step.

Step 3: Develop an effective strategy.

This is important to reduce future denials, saving the facility valuable time and money.

Optimally this would be done using machine learning software and advanced analytics specifically designed for claim denial management. These systems work with large data sets, and can potentially save millions in lost revenue.

Other helpful strategies include:

  • Double checking codes.
  1. CPT codes, Point of Service codes, and ICD-10 codes are easily confused.
  • Researching the correct number of digits entered for each type of code.
  • Making sure the code matches the treatment provided.

In short, pay attention to your claim denials! They can cause a significant loss of revenue when not acted upon. There are appropriate ways to deal with claim denials:

  1. Motivate your staff.
  2. Research common trends.
  3. Create an effective strategy.

These steps should help your facility avoid claim denials and ultimately a large loss of revenue.

For more info on this topic and many others please visit LTC Blogs.

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Social Security Number Removal Initiative (SSNRI)

To remove Social Security Numbers (SSNs) from all Medicare cards, the SSNRI initiated the Medicare Access and CHIP Re-authorization Act (MACRA) of 2015. This bill was considered and passed by the House on March 26th, 2015. And with a yea-nay vote of 92-8, it was considered and passed by the Senate on April 14th, 2015. This means that the SSN based numbers would have to be replaced with a Medicare Beneficiary Identifier (MBI) since the Center for Medicare and Medicaid Services (CMS) uses an ID Health Insurance Claim Number (HICN) based with the beneficiary’s SSN.

The conditions of the passed bill are as follows:

  • All beneficiaries will receive an MBI. This includes existing (currently active, deceased, or archived) and new beneficiaries. In the initial enumeration, 150 million MBIs (60 million actives and 90 million deceased or archived), will be assigned by an MBI generator
  • New and redesigned Medicare cards containing the MBIs to all beneficiaries will be issued.
  • The modification of systems and business processes will be needed. This means that updates are required for accommodation of receipt, transmission, display, and processing of the MBI.

Why the change?

The reason why CMS is making this massive move is mainly to save Medicare beneficiaries from medical identity theft. To protect private and federal health care benefits, financial information, and service payments in a more efficient manner, the SSN based HICN must be replaced on all Medicare cards. With 10,000 U.S. citizens enrolling in Medicare daily and the expectation of about 80 million U.S. citizens being Medicare eligible by 2035, the decision to be safe than sorry could not be more important.

Medicare beneficiaries, advocacy groups, the General Accountability Office, and Congress have all expressed the urgent necessity of removing SSNs from Medicare cards and CMS has listened to their voices. CMS explained in a press release on May 30th, 2017 that “People age 65 or older are increasingly the victims of this type of crime. Incidents among seniors increased to 2.6 million from 2.1 million between 2012 and 2014, according to the most current statistics from the Department of Justice.” This statement not only proves that SSNs do not belong out in the open but that identity thieves are evolving to a more sophisticated level as years pass by.

When will the new Medicare cards be distributed?

Making the move to the new Medicare numbers possible means that Medicare, as well as healthcare facilities, are required to adjust their systems and processes accordingly. The good news is that CMS has already started working on the adjustments and they plan for the official change to launch as early as April of 2018. CMS will begin by mailing the new Medicare cards including the MBI to all Medicare beneficiaries.

To avoid confusion with regards to the new numbers, until December 31st, 2019, CMS plans to have a transition period which allows the beneficiary to use either the HICN or MBI. During this transition period, CMS will actively monitor the widespread adoption of the new MBIs to make sure that most beneficiaries are prepared to only use MBIs by January 1st, 2020. After this transition period, there will be a few exemptions that will allow the use of the old HICNs. These exemptions are:

  • Appeals
  • Adjustments
  • Some reporting

The transition period will allow the facilities to file claims using the old HICNs, even though the systems will be adjusted to use the new MBIs by April of 2018.

How will the new MBI numbers look?

There will be a clear difference between the old HICN numbers and the new MBI numbers. All MBIs will be randomly generated, have a length of 11 characters, and will be made up of only numbers and letters.

To avoid possible confusion, the letters S, L, O, I, B, and Z will not be used. Any combination of numbers and/or letters that may be either inappropriate or offensive will not be used.

Here are some more details on how the MBI will look:

  • The MBI’s 2nd, 5th, 8th, and 9th characters will always be a letter.
  • Characters 1, 4, 7, 10, and 11 will always be a number.
  • The 3rd and 6th characters will be a letter or a number.

Here is an example of what the new MBI will look like:


Another change to the Medicare card will be that the gender and signature line will be removed.

Although the Medicare numbers are being changed for avoiding identity theft, the MBIs are still considered Personally Identifiable Information. This means that the numbers must be protected the same way as the HICNs and the numbers can only be shared for Medicare related business.

I am worried about the transition; How will the process work?

CMS will make sure that the transition process is a smooth one. They will work with states to remove the current HICN numbers and replace them with the new MBI based Medicare cards. Beneficiaries will receive a handbook titled “2018 Medicare & You” this coming October, which will include information about the new MBI numbers. Starting as soon as September of 2017 and lasting until around April of 2019, CMS will provide robust and broad-based outreach and education to the following:

  • Approximately 60 million beneficiaries, their families, advocacy groups, and caregivers
  • Health Plans
  • The provider community (1.5M providers)
  • States and Territories
  • Other business partners, including vendors

Beneficiaries will be instructed to safely and securely destroy their old Medicare cards and to replace it with the new and confidential MBI based cards upon their receiving of the new cards. CMS is working to develop a secure alternative for beneficiaries to access their new MBI when needed.

Stressed about these new Medicare changes?We can help.

Our staff is already working with software providers to ensure a smooth transition. We are currently putting internal processes in place to ensure our client and their residents are not affected negatively by this needed security measure. To learn more about how we can help please visit our website here or call 855-582-2600.