MEPBS Modernization Elevates Medicare

There are big deals, there are huge deals, and then there’s upgrading the Medicare Entitlement and Premium Billing Systems (MEPBS).

The upgrade represents a monumental step towards completion of the migration to Amazon Web Services (AWS) for the entire Medicare Enrollment & Payment Systems (MEPS), which encompasses MEPBS plus Medicare Advantage and Part D processing. 

“If we had to give the project a T-shirt size,” says Medicare Enrollment and Payment Systems Expert Tammy Johnson, “it would be the largest: XL. But XL doesn’t do justice to the project size. It’s really at least a 4XL.”

The project to modernize MEPBS by moving it to the cloud and upgrading functionality began in April 2019. It involved 30 contractor staff along with five full-time Division of Medicare Systems Support employees. 

Huge Gains

The value of these changes to CMS are enormous. Some of the critical outcomes which reduced costs, increased efficiency, enhanced analytic capability, and improved security are:

• Replacing and simplifying several complex mainframe business processes involving over 40 database tables

• Capturing Part A & B coverage periods, beneficiary full name, and mailing address details, allowing additional data to be used for CMS-wide calculations and derivations

• Aligning with the Social Security Administration’s (SSA) current data sharing format, enabling the capture of SSA data, and ensuring synchronization between the two agencies, which improves data quality, accuracy, and consistency 

• New event-driven processing that incorporates automatic recalculations of beneficiary entitlement and premium statuses/amounts based on independent changes to various beneficiary attributes – SSA and CMS exchange 100,000 to 500,000 such beneficiary transactions daily – further improving accuracy and reducing processing risks

• Eliminating redundant copies of Medicare Beneficiary information across the CMS enterprise and at CMS business partner locations, thereby reducing CMS’s security risk

In short, the new MEPBS will make the lives of OIT customers and Medicare beneficiaries a whole lot easier. 

Moving Weight

There are several reasons why the MEPBS modernization was such a big lift. 

The first hurdle was legacy business processing. The new system replaces the enrollment database (EDB) mainframe applications that exchange data with SSA and the Railroad Retirement Board, and those that calculate direct billing of Medicare premiums, Income Related Monthly Adjustment Amounts, and Managed Care premium reduction amounts. 

Another challenge was ensuring that new event-driven micro-services were operating correctly. This took months of unit, system, regression, performance, and parallel testing. Validating test evidence required collaboration with several stakeholders including OIT, the Center for Medicare, the Office of Financial Management, the Offices of Hearings and Inquiries, and the Office of Communications.

Using parallel processing, the team tested multiple versions – and subcomponents – of applications on different systems simultaneously to reduce the amount of time needed to conduct testing. 

“By the time we flipped the switch from mainframe processing to the cloud, we were confident that additions, updates, and deletes were the same on the mainframe and in AWS” says Johnson. “The new version performs correctly, efficiently, and consistently.”