Dancing With Data: How ESSG Choreographs the Annual Medicare Benefit Rate Increase

Every autumn, the temperature begins to drop, leaves change color before falling off the trees, dusk descends earlier each night, and 65 million Medicare beneficiaries receive updated Medicare premium rates. 

While the American public can rely on rate adjustments arriving on schedule as reliably as the seasons, those rates are not a product of Mother Nature. They are the result of a tightly choreographed dance among multiple federal agencies – CMS, the Social Security Administration (SSA), the Railroad Retirement Board (RRB), the Internal Revenue Service (IRS), the Bureau of Labor Statistics – and print/mail vendors, with a healthy dose of orchestration by OIT’s Enterprise Systems Solutions Group.  

The two biggest factors that feed into the beneficiary’s new Medicare rates are the SSA’s Cost of Living Adjustment (COLA), which is based on the Bureau of Labor Statistics’ Consumer Price Index (CPI), and CMS’s Office of the Actuary’s (OACT) final determination of the Medicare Part B premium rate.   

Practice Makes Perfect

Coordination among agencies means that several backend systems must interact with each other. Starting in April each year, CMS and SSA begin coordination efforts, followed by vigorous testing activities from August until November. First, they begin with “fictitious” rates, which are estimations of what the new rates will be.

CMS OACT typically finalizes Medicare real rates by mid-October. At this point, databases are restored to their pre-fictitious validation states, and new tests are run with real rates. 

The Last Dance

If the BRI Event is a theatrical performance, then “BRI Day,” which takes place annually the Friday before Thanksgiving, is the climax. On November 18 between 3:30 and 6 a.m., CMS systems processed approximately 7.5 million transactions from SSA.

This year, CMS’s BRI processing occurred in a hybrid fashion, with the database residing on the mainframe and the processes executing in the cloud and the mainframe. 

“Transaction processing completed three times faster in this hybrid environment and without a hitch,” says Medicare Enrollment and Payment Systems Program Expert Tammy Johnson. “We went from 3,000 to 9,000 transactions per minute.”

BRI Day starts when CMS receives the Combined Exchange Record (CER) from SSA early Friday. The first step is to filter out entries that don’t need immediate updating. After the files are processed, adjustments are made to the Enrollment Database (EDB) – where Premium Due Amounts are amended – to support Medicare entitlement, direct billing, and third-party billing business applications. 

BRI Day ends within seven hours when CMS sends SSA a premium due amount inquiry file. SSA uses this information for their benefit payment adjustments, so they can deduct premium arrearages or refund overages. The most common scenarios for these adjustments are Title II payment resumptions and third-party payer changes.

And those filtered, non-immediate transactions? With the hybrid environment, they are now processed on the Saturday and Sunday after BRI Day. In previous years, that would take two weeks on the mainframe.       

By the morning of Saturday November 19, Medicare beneficiaries could view their new Medicare premium rates online.  For 2023, the Part B premium rate decreases from $170.10 per month to $164.90, the first reduction in over a decade.

At this point, the BRI team can pause, take a breath, and turn their attention to preparing for the holidays, which may or may not be just as stressful.

Lessons Learned

After years of refining the BRI process, the staff at ESSG have homed in on practices that ensure a seamless update. These include:

• Numerous collaboration meetings and Outlook reminders for SSA/CMS Checkpoint Calls
• Early dry run execution, including volume, performance, and parallel/comparison testing of mainframe and cloud environments
• Early receipt of production CER files from SSA allowing the EDB to gain valuable processing time during non-peak hours
• Filtering out records that do not need to be processed during BRI Day, thereby reducing the EDB runtime
• Creating a comprehensive checklist of runtime activities
• Using direct billing progress indicators to assess and predict job performance