On October 1, 2012, CMS released Transmittal 2449 regarding the use of beneficiary names in Medicare claims processing. The beneficiary name on a Medicare claim must now exactly match the name on record provided to Medicare by the Social Security Administration (SSA). When a beneficiary data element on a claim (such as the name, date of birth, HICN, etc.) does not precisely match Medicare records, the claim will be rejected or denied. The name must be submitted exactly as it appears on the beneficiary’s Social Security Card, including apostrophes, spaces and/or hyphens and Jr./Sr. suffixes.
ADVOCATE staff is working with your staff and/or the hospital staff to better capture accurate data during patient registration. We will be working with them to:
- Always obtain a copy of the most recent version of the beneficiary’s Medicare card (which is issued by the SSA).
- Ask the beneficiary if their name has changed since the card was issued.
- Use the name exactly as it is printed on the beneficiary’s Medicare card (unless the beneficiary has told you that their name has changed and been updated with the SSA).
If Medicare systems rejects a claim when the beneficiary name is not an exact match, the Medicare contractor will return the claim as unprocessable with the identifying Reason Code 140 (Patient/Insured health identification number and name do not match).
When this happens:
- We have established means to access the SSA database to obtain the correct information. However, this functionality is not available on the front end, it is only allowed for claim denials.
- In cases where we need to get the patient involved, we are advising patients that we must bill with the same information the SSA has on file, advising them to contact our office to provide this information.
- We are training all customer service representatives to articulate to patients that we need their billing information EXACTLY as it appears with the Social Security Administration (spelling, junior, senior, etc).
These denials are overturned and paid once we obtain the corrected beneficiary data. We are working to eliminate the denial by improving the front end data we receive from each host facility. We will continue to monitor the situation closely and keep you informed.
Kirk Reinitz, CPA