CMS News Center

New Medicare Cards Expected to Combat Fraud, Illegal Use 

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud-prevention initiative that removes Social Security numbers from Medicare cards to help avoid identity theft and safeguard taxpayer dollars. The new cards will use a unique, randomly assigned number called a “Medicare Beneficiary Identifier” (MBI) to replace the Social Security-based health insurance claim number (HICN) system currently used on Medicare cards, officials said. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019.

“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers, which can lead to identity theft and illegal use of Medicare benefits,” said Seema Verma, CMS administrator. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.” 

Providers and beneficiaries will both be able to use secure search tools that will support quick access to MBIs when needed, according to officials. There will also be a 21-month transition period during which providers will be able to use either the MBI or the HICN. CMS testified on May 23 before the United States House Committee on Ways & Means’ Subcommittee on Social Security and U.S. House Committee on Oversight & Government Reform Subcommittee on Information Technology, addressing CMS’ comprehensive plan for the removal of Social Security numbers and transition to MBIs. For more information, visit: www.cms.gov/medicare/ssnri/index.html

Review 2017 Program Requirements on the EHR Incentive Website

Eligible professionals (EPs) who demonstrated Meaningful Use successfully in a prior year for the Medicare EHR (Electronic Health Record) Incentive Program can determine their participation status in the Quality Payment Program for 2017 through a search tool on the Quality Payment Program (QPP) website (https://qpp.cms.gov/). Information will then be provided on whether or not EPs should participate in the Merit-Based Incentive Payment System (MIPS) this year, and where to find resources.

If EPs are new to Medicare in 2017, they do not participate in MIPS. EPs may also be exempt if they qualify for one of the special rules for certain types of clinicians or are participating in an Alternative Payment Model (https://qpp.cms.gov/learn/apms). To learn more, review the MIPS Participation Fact Sheet at https://qpp.cms.gov/docs/QPP_MIPS_Participation_Fact_Sheet.pdf

EPs who are not in the QPP in 2017 can participate voluntarily and will not be subject to payment adjustments.

The Centers for Medicare & Medicaid Services recently sent letters notifying clinicians of their MIPS participation status. A sample of the letter can be found at https://qpp.cms.gov/. This tool is another resource for clinicians to use to determine status. For EPs participating in the Medicare EHR Incentive Program for the first time in 2017, one of the following actions must be taken by Oct. 1, 2017, to avoid the 2018 payment adjustment:

• Attest to the modified stage II 2017 EHR Incentive Program requirements or
• Submit a one-time hardship exception application if transitioning to the MIPS path of the QPP and plan to report on measures specified for the “advancing care information” performance category.

The one-time hardship exception application can be found at www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/paymentadj_hardship.html. EPs who attest directly to a state for that state’s Medicaid EHR Incentive Program will continue to attest to the measures and objectives finalized in the 2015 EHR Incentive Program Final Rule (80 FR 62762-62955). In 2017, Medicaid EPs have the option to report to the modified stage II or III objectives and measures. As a reminder, EPs who are eligible only for the Medicaid EHR Incentive Program are not subject to payment adjustments. For more details, visit www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/2017programrequirements.html

Beneficiaries Benefit From Quality Improvement Organizations, Report Claims

In 2016, millions of Medicare beneficiaries from across the country benefited from the work of quality improvement organizations (QIO), according to a recent report.

QIOs work regionally with healthcare providers via 14 quality improvement networks to improve the health quality of Medicare beneficiaries. The breadth, depth, and scope of the work is detailed in the 2016 QIO Program Progress Report by the Centers for Medicare & Medicaid Services (CMS): https://progressreport.qioprogram.org/.

A few highlights from the report include (all numbers are for 2016):

• More than 24,300 readmissions to hospitals were avoided (with 350 communities engaged on how to reduce readmissions affecting a potential 23 million beneficiaries).
• More than 27,850 Medicare beneficiaries completed diabetes self-management education.
• 3.7 million Medicare beneficiaries were impacted through education and outreach about the importance of immunization.
• More than 544,250 pneumonia and flu immunizations were administrated by clinicians and healthcare practices participating with QIOs.
• 1.2 million beneficiaries at high risk for an adverse drug effect were screened and avoided medication regime problems and unnecessary pain.

Technical Assistance Resource Guide Now Available

The Centers for Medicare and Medicaid Services (CMS) recently published the Technical Assistance Resource Guide, which concisely highlights all of the support that is available to clinicians participating in the Quality Payment Program. The guide contains brief summaries on each branch of technical assistance, contact information, and maps to illustrate coverage areas. Access the guide is available at https://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf.