The Centers for Medicare and Medicaid Services (CMS) announced a significant change impacting Medicare providers nationwide. By March 31, 2025, Medicare Administrative Contractors (MACs) will remove beneficiary eligibility information from their Interactive Voice Response (IVR) systems.
This means that the longstanding option to call in and verify Medicare patient eligibility and benefits (EAB) will be discontinued. CMS is making this move to bolster security and protect beneficiaries, but it will require providers to rethink how they access this vital information.
Some MACs have indicated they will make this change in February while others have stated they will adjust their IVR systems as early as this month. As the March deadline gets closer, we expect to see more and more companies following suit. Now is the time for providers to consider their options and select a new plan. With preparations in place, teams can move forward while continuing to optimize Medicare reimbursement.
The details
Until now, providers could call the IVR system, verify their identity using their National Provider Identifier (NPI), Provider Transaction Access Number (PTAN), and the last five digits of their Tax Identification Number (TIN), and then enter patient details like the Medicare Beneficiary Identifier (MBI), name, and birthdate.
Once verified, the IVR system would share key eligibility details, including (but not limited to):
- Deductibles and coinsurance
- Part A and Part B entitlement dates
- Medicare Secondary Payer
- Qualified Medicare Beneficiaries
- Remaining hospital lifetime reserve days
- Eligibility for varying services
- Preventative care details
These details are useful for coordinating care, advising patients on ideal appointment dates, and managing insurance reimbursements. However, CMS’s recent decision removes all these options from the IVR system, prompting a need for new tools and processes to continue seamless care delivery and reimbursement tracking.
What does this mean for providers?
Medicare plays a crucial role in the revenue stream of many healthcare providers, often accounting for a significant portion of monthly revenue. Some organizations have long relied on the simplicity of the IVR. However, with the shift, it’s essential to secure a reliable and HIPAA-compliant alternative that ensures continuous access to Medicare eligibility information.
With the IVR tool phased out, any disruption in eligibility verification could have a notable impact on timely revenue recovery and patient care. Providers who relied on the IVR for EAB verification will need to find new solutions before the March 31, 2025 deadline. Preparing now can help prevent interruptions in revenue flow and maintain service quality.
Third-party options, including clearinghouses, billing agencies, and software vendors, can seamlessly replace the IVR by providing up-to-date Medicare eligibility information. This is where Office Ally can offer crucial support.
Office Ally’s Medicare Eligibility tool
With Office Ally, you can transition seamlessly to a Medicare eligibility tool that’s intuitive, compliant and reliable. Office Ally’s Medicare Eligibility tool can make the process smooth and efficient by making use of the following features:
- Quick onboarding: Perhaps most importantly given the looming deadline, Office Ally can complete onboarding in less than an hour after an agreement is signed. This lets you avoid downtime during the IVR phase-out.
- Easy integration: Office Ally’s tool requires standard file extracts; no specialized technical resources are required on your end.
- Proven track record: Office Ally has helped providers identify revenue recovery opportunities they might otherwise miss, which is especially critical when Medicare revenue is at stake.
- Revenue optimization: Our coverage identification system helps you maximize revenue recovery by ensuring every Medicare-eligible claim is accounted for, reducing the chances of missed payments.
Preparing for change
The upcoming CMS change may be daunting, but it also provides an opportunity to update your systems, enhance security, and even improve efficiency. With Office Ally’s Medicare eligibility tool, you’ll have a seamless, HIPAA-compliant alternative that keeps your revenue cycle flowing without disruption.
Don’t wait—reach out to Office Ally today to ensure you’re fully prepared for this shift. Contact us to learn more about our Medicare eligibility solution and how we can support your organization in maximizing revenue and delivering uninterrupted care.