If you're running a skilled nursing facility (SNF) or managing hospice care, you know that billing and compliance issues can quickly turn into costly headaches.

One small mistake — like an incorrect Medicare Beneficiary Identifier (MBI) — can lead to claim denials, delayed reimbursements, and unnecessary audits. But navigating MBIs doesn’t have to be a challenge.

In this article, we’ll cover:

• What MBIs are and how they work

• How MBIs impact skilled nursing and hospice providers

• How ExaCare helps administrators ensure compliance and billing accuracy

What is an MBI Number?

Medicare Beneficiary Identifiers (MBIs) are unique, 11-character alphanumeric codes assigned to every Medicare recipient. If your facility provides skilled nursing or hospice care, using the correct MBI is essential for claims processing and compliance.

Without it, claims are automatically rejected, delaying payments and creating unnecessary administrative headaches.

How MBIs replaced social security-based Medicare numbers

Before 2018, Medicare used Social Security numbers (SSNs) as identifiers — a practice that posed serious risks for identity theft and fraud. To improve security, CMS replaced SSN-based Medicare numbers with MBIs.

Unlike the old system, MBIs are randomly generated, making them harder to misuse or predict. For SNFs and hospice providers, this means every patient’s Medicare number must be recorded and used correctly. Even minor errors — such as entering an old SSN-based number — can lead to claim denials and billing delays.

How to find a patient’s MBI (if they don’t have their Medicare card)

It’s not uncommon for patients to forget or misplace their Medicare cards, leaving your team scrambling to track down their MBI. Here’s how you can retrieve it:

• Check your records: If the patient has been admitted before, their MBI may already be saved in your system.
  
  

• Ask the patient or their caregiver: Some patients keep a written record of their MBI even if they don’t have their card.
  
  

• Use the Medicare MBI lookup tool: Medicare provides an online lookup tool for authorized providers to retrieve MBIs using patient details.

How ExaCare helps

Managing MBIs manually can slow down admissions and lead to billing errors. ExaCare simplifies this by centralizing referral management, automating document review, and ensuring all essential patient details — like MBIs — are readily available.

With built-in analytics and streamlined workflows, administrators can reduce manual errors, prevent claim denials, and keep operations running smoothly.

How MBIs impact skilled nursing and hospice providers

MBIs play a crucial role in SNF and hospice billing. Without the correct MBI, claims are automatically rejected, leading to delayed reimbursements and potential compliance issues. Since Medicare no longer accepts Social Security-based numbers, facilities must ensure accurate MBI entry for every patient.

How SNFs use MBIs for Medicare Part A and B services

Skilled nursing facilities rely on MBIs for both Medicare Part A (which covers short-term skilled nursing care, rehab, and inpatient stays) and Medicare Part B (which includes outpatient services, therapy, and medical supplies).

Every claim submitted must include the patient’s MBI, and even minor errors can lead to payment delays. Ensuring correct MBI usage is critical for maintaining cash flow and avoiding rework.

When a patient elects hospice care, their Medicare coverage shifts. Under Medicare rules:

• SNF care under Part A stops: Medicare won’t pay for SNF services once hospice is elected, unless the patient revokes hospice or qualifies for specific non-hospice SNF benefits.
  
  

• Hospice takes over: Medicare covers hospice-related services, but non-hospice care (like rehab or therapy) may no longer be billable.
  
  

• Billing mistakes can lead to claim denials: If a facility accidentally submits an SNF claim after hospice is elected, Medicare will reject it.

SNF vs. Hospice coverage: Key differences

|          Service         | Covered Under SNF (Medicare Part A)? |            Covered Under Hospice?            |
|:------------------------:|:------------------------------------:|:--------------------------------------------:|
|   Skilled nursing care   |         ✅ Yes (if qualified)         | ❌ No (unless unrelated to hospice condition) |
| Therapy (PT, OT, Speech) |         ✅ Yes (if qualified)         | ❌ No (unless unrelated to hospice condition) |
|      Palliative care     |                 ❌ No                 |                     ✅ Yes                    |
|        Medications       |          ❌ Not fully covered         |    ✅ Yes (for hospice-related conditions)

How ExaCare helps

By centralizing patient data and automating document review, ExaCare ensures MBIs are correctly recorded, preventing claim errors. Built-in analytics and workflow tools help facilities track patient transitions, avoid billing mistakes, and help you to comply with Medicare requirements.

What staff should know about Medicare MBI & hospice guidelines

Regular education on Medicare guidelines ensures teams can confidently manage transitions between SNF and hospice care without risking claim denials. Here’s what your staff should know:

How MBIs are used when a patient elects hospice care

Once a patient chooses hospice, Medicare no longer covers their skilled nursing stay under Part A. Instead, hospice benefits take over, covering palliative care and related services.

However, if a patient still needs skilled nursing for reasons unrelated to their hospice diagnosis, Medicare may allow SNF billing under Part B. The correct MBI must be used on claims, reflecting the patient’s hospice status to avoid denials.

The impact of hospice election on SNF billing

Hospice election means:

• SNF services under Medicare Part A stop: Facilities can’t bill Medicare for routine skilled nursing care once a patient elects hospice.
  
  

• Part B is limited: If a patient requires therapy or other services unrelated to their hospice diagnosis, those may still be billable under Part B, but documentation must clearly justify it.
  
  

• Medicare tracks hospice status closely: Submitting an SNF claim for a hospice patient can result in denials, delayed reimbursements, or compliance red flags.

Preventing claim denials due to MBI mismanagement

Billing mistakes often happen when staff aren’t aware that a patient has elected hospice or when MBIs aren’t updated in the system. Common errors include:

• Using an old MBI linked to the patient’s SNF coverage after hospice election

• Submitting SNF claims under Part A without verifying hospice status

• Failing to properly track which services are still eligible for Medicare reimbursement

To prevent these issues, staff should always verify MBI status before submitting claims and coordinate with hospice providers to ensure coverage details are clear.

How ExaCare helps

ExaCare simplifies MBI management by centralizing patient data and automating key processes. Administrators can track patient transitions between SNF and hospice, ensuring billing teams always have the right MBI and eligibility details.

Billing and claims processing with MBIs

When a patient elects hospice, their Medicare coverage shifts, and any billing tied to their MBI must reflect that change. Failing to update records or using an outdated MBI can result in automatic claim denials — especially when SNF and hospice benefits overlap. 

Medicare rules for submitting claims with MBIs

Medicare requires that:

• MBIs must be correctly entered on all claims — Social Security-based Medicare numbers are no longer accepted.
  
  

• Claims must reflect the patient’s current Medicare status, including hospice election or SNF eligibility.
  
  

• If a patient transitions from SNF to hospice, billing must align with Medicare’s coverage rules to avoid rejections.

Facilities often face claim denials due to:

• Incorrect MBIs: Even one wrong digit can cause a claim to be rejected.
  
  

• Outdated MBIs: If a patient was recently reassigned a new MBI, old records may cause billing errors.
  
  

• MBI linked to the wrong coverage: Submitting SNF claims under Part A after a patient elects hospice can result in automatic denial.

How ExaCare helps

ExaCare minimizes billing errors by automating document review and centralizing patient data. With streamlined workflows, facilities can track MBI changes, ensure accurate data entry, and prevent claim rejections before submission.

What happens if an MBI is entered incorrectly on a claim?

If an MBI is incorrect, Medicare will reject the claim outright. Your team will then need to:

• Retrieve the correct MBI through Medicare’s lookup tool or patient records.

• Resubmit the claim with the correct MBI, which can delay payments.

• Ensure internal records are updated to prevent future errors.

Repeated MBI errors can lead to compliance concerns, increased administrative workload, and potential scrutiny from Medicare auditors.

Compliance best practices for administrators and staff

Keeping track of MBIs is more than just a billing issue — it’s essential for compliance. Here’s how administrators can ensure accuracy:

• Ensure accurate MBI entry in patient records: Train staff to double-check MBIs before submitting claims.
  
  

• Track hospice election status and SNF benefit periods: Monitor when patients transition between SNF and hospice to avoid claim denials.
  
  

• Prevent duplicate billing: Medicare audits can occur if claims are submitted incorrectly for SNF and hospice at the same time.

Frequently asked questions

What is the format of an MBI?

An MBI is an 11-character alphanumeric code that follows this structure: XXXXXXXXXXX (e.g., 1EG4-TE5-MK73). It does not include dashes when submitted on claims and is randomly generated to protect patient identity.

Can a patient’s MBI change?

Yes, in certain cases. If a patient is issued a new MBI due to identity theft, fraud, or administrative corrections, Medicare will notify them, and providers should verify the updated number through the Medicare MBI Lookup Tool.

What do I do if Medicare denies a claim due to MBI issues?

First, confirm that the MBI was entered correctly — check for typos, missing digits, or outdated numbers. If the MBI is correct, verify the patient’s Medicare eligibility and coverage status. If issues persist, contact your Medicare Administrative Contractor (MAC) for further guidance.

Can SNFs bill for services after a patient elects hospice?

It depends on the services. Once a patient elects hospice, Medicare Part A will no longer cover SNF services related to their terminal condition. However, SNFs may still bill Medicare Part B for unrelated treatments, therapy, or physician services if properly documented.

How do teams confirm hospice election status using an MBI?

Hospice election is linked to the patient’s MBI within Medicare’s records. Providers can verify a patient’s current coverage by checking their Medicare eligibility through a billing system, an EHR with Medicare integration, or the MAC portal.

Get Medicare claims right the first time with ExaCare

MBI billing errors can lead to Medicare claim denials, delayed reimbursements, and compliance risks — problems no SNF can afford. Navigating MBIs, tracking patient transitions, and ensuring accurate claims submission require precision, but manual processes leave too much room for error.

ExaCare eliminates the guesswork by streamlining data management, automating document review, and ensuring claims are accurate before submission. Our AI-driven platform helps your facility maintain compliance, reduce administrative burdens, and keep revenue flowing without disruptions.

Here’s how ExaCare supports your team:

• AI-powered referral screener: Reviews hospital packets in minutes, enabling quick and accurate admissions decisions.
  
  

• Centralized referral management: Unifies all referral sources into one platform, eliminating the need to switch between systems.
  
  

• Built-in analytics: Tracks performance metrics, helping you optimize referral relationships and improve operational efficiency.
  
  

• Automated insurance verification: Flags potential reimbursement risks and alerts staff to expensive medications before acceptance.
  
  

• Unified communication hub: Simplifies collaboration between staff, reducing miscommunications that lead to billing errors.

Ready to see how ExaCare can improve your billing and claims process? Talk with our team to learn more.

Schedule a demo.