In September, the Centers for Medicare and Medicaid Services (CMS) announced a change that many initially missed: Medicare Administrative Contractors (MACs) will remove beneficiary eligibility information from their interactive voice response (IVR) systems by March 31, 2025. Some have already begun to do so.

With this change, CMS aims to improve security, reduce fraud, and protect those receiving Medicare benefits. However, this change also means providers will no longer be able to call MACs to acquire necessary eligibility information via IVR, including regarding: deductibles and coinsurance; Part A and Part B entitlement dates; qualified Medicare beneficiaries; and more.

What does this mean for patient support teams?

Pharmaceutical patient support teams and teams within pharma hubs will need new, HIPAA-compliant ways to gather this information for locally covered drugs, and will need them quickly. Disruption in eligibility verification could negatively impact both patient care and revenue flow

While CMS says removal of benefits data from MACs’ IVR systems is only a pilot program, there is no guarantee benefits data will ever return to IVR – meaning action needs to be taken now regardless of what may happen in the future. 

How to prepare for the removal of Medicare IVR tools

Patient support teams don’t have to rush to find a workaround or stopgap measure. Infinitus offers a comprehensive AI solution for patient support teams that must verify Medicare patient benefits. Our solution is HIPAA-compliant and doesn’t rely on data from IVR systems. Plus, we can onboard new customers fast – ensuring this change won’t put patients’ continuity of care at risk. 

In addition to partnerships with third-party data sources and direct access to CMS data, our solution is made possible by our proprietary knowledge graph. The Infinitus knowledge graph contains up-to-date intelligence on both commercial and government payor rules and guidelines that have been gathered from the millions of phone calls completed to date by Infinitus AI agents, plus access to EDI, payor APIs, and policy documents.

Infinitus AI agents can collect all data that has traditionally been available via IVR, as well as other coverage guidelines that are often necessary to clear the way for patients to receive treatment. Finally, because it is an AI solution, Infinitus is more cost effective than human team members navigating IVRs or waiting on hold. 

If you don’t yet have a plan to navigate these critical Medicare benefit eligibility accessibility changes, we can help. Reach out to the Infinitus team today to ensure your patients don’t face delays in treatment and you don’t risk losing revenue.