Miscellaneous goings-on with Medicare/CMS


New Medicare Card: Using Your MAC’s MBI Look-Up Tool

When you use the Medicare Administrative Contractor (MAC) secure portal Medicare Beneficiary Identifier (MBI) look-up tool, you must use your patient’s own Social Security Number (SSN) along with your patient’s first name, last name, and date of birth. Your patient’s SSN may differ from the number part of the Health Insurance Claim Number (HICN), which uses the SSN of the primary wage earner on whom benefits are based. The original Medicare card, with a HICN, of a spouse, widow, or other dependent will have the SSN of the wage earner; ask for your patient’s SSN to use in the look up tool. If you do not have access to the tool, sign up.

If you use your patient’s SSN and the look-up tool does not return an MBI, be sure you are using the full last name exactly as it appears on the Medicare card. You may want to include any suffix, such as Jr, Sr, or III.


To ensure people with Medicare continue to get health care services, you can use the HICN through December 31, 2019, or until your patient brings in a new card with the new number.

E/M Coding Reform: Recording of Panel Discussion

CMS proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. We held listening sessions all over the country and heard from thousands of providers and one thing they consistently brought up was how documentation was needlessly burdensome, was not improving patient care, and was actually having a negative impact on patient care. We listened, and in response, we proposed streamlining the documentation requirements for Evaluation and Management (E/M) visits, as well as moving to single payment rates.

Watch CMS Administrator Seema Verma, CMS Chief Medical Officer and Director of CCSQ Kate Goodrich, Dr. Donald Rucker, National Coordinator for Health Information Technology, Dr. Anand Shah, CMMI Chief Medical Office and Dr. Thomas A. Mason, ONC Chief Medical Officer discuss proposed E/M coding changes.

Watch videos on E/M:

Proper Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing

In a February 2018 report, the Office of the Inspector General (OIG) determined that Medicare payments to clinical laboratories and providers for specimen validity tests did not comply with Medicare billing requirements. A recent MLN Matters® Special Edition Article reminds laboratories and other providers about proper billing for specimen validity testing done in conjunction with drug testing; this article contains no policy changes.

Current coding for testing for drugs of abuse relies on a structure of presumptive and definitive testing that identifies the specific drug and quantity in the patient. This article includes descriptors for:

  • Presumptive drug testing codes
  • Definitive drug testing codes

Use the following resources to bill correctly and avoid overpayment recoveries:

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