Data related to an individual’s insurance coverage for healthcare.

Data Element
Medicare Patient Identifier
Description

Medicare Beneficiary Identifiers (MBI) used to uniquely identify Medicare patients.
Submitted By: Joel Andress / Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)
Data Element Information
Data Element Description Medicare Beneficiary Identifiers (MBI) used to uniquely identify Medicare patients.
Use Case Description(s)
Use Case Description Medicare beneficiary identifiers (MBI) are a standard patient identifier for Medicare patients across the United States. These patient identifiers are submitted with patient-level data to CMS for quality measure reporting, both for eCQMs and for claims-based measures.

Although an all-payer unique identifier is not yet available, Medicare beneficiary identifiers are fully standardized and available and assist with patient identification and matching, which is a good first step for patient identification.
Estimate the breadth of applicability of the use case(s) for this data element All Medicare beneficiaries have an MBI and all 4,000+ hospitals and providers reporting measure data to CMS currently have access to and are required to report this patient identification information.
Link to use case project page https://www.cms.gov/Medicare/New-Medicare-Card
Use Case Description For providers responsible for the care of a patient population, the ability to transfer and share information from encounters with their Medicare beneficiaries from providers outside of their network supports optimal quality of care.
Estimate the breadth of applicability of the use case(s) for this data element Hospital and outpatient providers participating in alternative payment models for Medicare beneficiaries, which is a growing stakeholder group.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) MBI format specifications: https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf
HL7 Identifier type value set, see MC (http://hl7.org/fhir/R4/v2/0203/index.html)

https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf
Additional Specifications HL7 FHIR US Core Implementation Guide STU3 based on FHIR R4, Patient Profile require a Patient ID. This profile already required to exchange other patient demographic information included in USCDI v1: https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-patient.html
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts Patient Medicare identifiers routinely captured in EHR systems, claims data and is used by hospitals, providers, and other healthcare stakeholders for submission to CMS for quality measurement reporting.
Widely available in EHR systems to support Patient FHIR resource:
https://fhir.cerner.com/millennium/r4/individuals/patient/
https://fhir.epic.com/Specifications?api=932
https://developer.allscripts.com/FHIR?PageTitle=Resources
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Programs
https://ecqi.healthit.gov/ecqms

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Programs
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts Medicare patient IDs electronically exchanged with CMS for quality measure reporting via QRDA files and other electronic exchange platforms; required as part of submission for Medicare beneficiaries included in the measures.
Provider-payer data exchange and member-mediated information exchange are also occurring, and include FHIR Patient profile with a patient ID, being testing in HL7 Connectathons.
https://ecqi.healthit.gov/qrda
https://build.fhir.org/ig/HL7/davinci-ehrx/profiles.html

https://ecqi.healthit.gov/qrda
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) Standard patient IDs only available for Medicare beneficiaries; no unique identifier for all-payer patients.
Restrictions on Use (e.g. licensing, user fees) N/A
Privacy and Security Concerns This data, like any patient data, should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data. MBI is a unique randomly generated ID with “non-intelligent” characteristics, which replaced the HIC Number, based on SSN.
Estimate of Overall Burden No/low burden anticipated, as Medicare identifiers already in wide use among stakeholders caring for Medicare beneficiaries. Patient FHIR US Core profile also required by the US Core Capability Statement and required for exchange of other patient demographic data included in USCDI version 1; a patient ID is required for inclusion in this profile. Therefore, all stakeholders complying with ONC CEHRT requirements will have ID data ready for exchange in standards.
Other Implementation Challenges N/A
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment This data element represents a specific type of an existing USCDI data elements Member Identifier in the Health Insurance Information data class.

Comment

Submitted by maria.michaels… on

Specific Identifier(s) or general Identifier?

MedMorph supports the addition of Medicare Patient Identifier (level 2), but is concerned with having a general Identifier element (level 2) as well as Medical Record Number (Level 1) and Patient Social Security Number (level 1). What is the intention of Identifier - is it a placeholder for a national identifier of some sort for a patient?  We recommend that USCDI either take a general approach with Identifier Type, Identifier System, and Identifier Value OR be specific with Medical Record Number, Medicare Patient Identifier and Social Security Number elements (and remove the Identifier element).

Submitted by CDC_DSMH_WG on

Recommendations for Updated Submission

We've reviewed and submitted feedback on the submission we've put forward for Patient Medicare Number, and we believe the information provided differs from the submission here, which has been referenced when told we submitted a duplicate. We believe our submission should be revisited as it differs in some areas to the submission seen here.

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