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06/01/2016

Employers Be On the Lookout for CMS Data Match Letters

By: Erin Shick, Esq.—Ledbetter Parisi LLC

The Centers for Medicare and Medicaid Services (CMS) have recently began sending letters to employers regarding a joint Data Match Project in collaboration with the Social Security Administration and the Internal Revenue Service. The letter is called “Requirement to Submit the Group Health Plan Report for the IRS/SSA/CMS Data Match Project.” Essentially, the Data Match Project is an effort by CMS to identify primary and secondary payers for medical services provided to Medicare beneficiaries. Many employers receive this letter and have no idea what it means. Some employers assume the letter is fraudulent and others assume their plan administrator will complete the Data Match Questionnaire on behalf of the plan or that the letter is referring to the annual Medicare Part D filing. The letter is not fraudulent, the plan administrator will not complete the Questionnaire and this Questionnaire is entirely separate from the Medicare Part D filing. Employers must complete the Questionnaire within 30 days of receiving the letter from CMS. If the employer does not complete the Questionnaire within the 30 days, CMS may assess a fine of up to $1,000 for each employee for whom an inquiry regarding coverage was made. Employers can request an additional 30 day extension from CMS to complete the questionnaire but CMS cautions that most employers with less than 150 employees will not be granted an extension.

            If an employer receives a letter, the letter will contain a Personal Identification Number (PIN). The employer will use the PIN and its Employer Identification Number (EIN) to create an account on the secure IRS/SSA/CMS Data Match Website. After an account is created, there is a one to two day wait so that the account can be connected with the Data Match program. The Questionnaire will ask questions about the plan generally, for example group ID number, RX PCN numbers and carrier information. For multi-employer group health plans there are also questions about the types of employers who participate in the plan. Employers will probably need information from the plan administrator to complete these sections. After the general questions, the Questionnaire will identify specific employees or their spouses who are Medicare-eligible. Generally, the Questionnaire will ask if each named individual worked during a specific time period and, if so, whether he or she had Group Health Plan coverage. To complete the Questionnaire, the employer will need to certify that the information is correct. The employer may receive a follow-up letter from the CMS/SSA/IRS requesting additional information.

            In short, if you receive one of these letters, do not ignore it. Begin the Questionnaire immediately to ensure that there is enough time to collect all of the information requested and coordinate with your plan administrator.

Questions? Contact Erin Shick at Ledbetter Parisi LLC at (937) 619-0900 or eshick@fringebenefitlaw.com