CMS Data Match Project Questionnaires and FAQs

Congress enacted a law (Section 6202 of the Omnibus Budget Reconciliation Act of 1989) to provide CMS with better information about Medicare beneficiaries’ group health plan (GHP) coverage. The law requires the Internal Revenue Service (IRS), the Social Security Administration (SSA), and CMS to share information that each agency has about whether Medicare beneficiaries or their spouses are working. The process for sharing this information is called the IRS-SSA-CMS Data Match. The purpose of the Data Match is to identify situations where another payer may be primary to Medicare.

Employers are required to complete the Data Match Questionnaire on identified workers who are either entitled to Medicare or married to a Medicare beneficiary. This information is used to identify the primary and secondary payers for medical services provided to a Medicare beneficiary. This process helps Medicare identify claims on an ongoing basis for which Medicare should not be the primary payer.

Recently, some employers that sponsor group health plans have received a letter from the Centers for Medicare & Medicaid Services (CMS) requesting the employer to submit the GHP report for the IRS/SSA/CMS Data Match Project.  IF AN EMPLOYER RECEIVES THIS LETTER FROM CMS, IT MUST TAKE ACTION IMMEDIATELY.

Why is CMS asking for this information?

CMS wants to confirm that claims it is paying on a primary basis should in fact be paid on a primary basis, as opposed paying on a secondary basis, after an employer group plan pays the claim first. To determine this, CMS identifies certain Medicare-enrolled individuals to the employer (through an online portal) and the employer indicates whether the person has coverage through the employer’s plan, and if so, whether the coverage is due to the individual’s or a relative’s (such as a spouse’s) “current employment status.”

What are the reporting requirements?

Employers must provide information regarding health coverage of their Medicare-eligible workers and spouses of Medicare-eligible individuals whenever CMS identifies those individuals to the employer. Generally, the questionnaire asks if each named individual worked during a specific time period, and if so, whether he or she had employer-sponsored group health plan (GHP) coverage.

If an employer receives a letter from CMS, how much time do they have to answer CMS’s questions?

Employers must respond within 30 days of receiving the initial inquiry from CMS, unless an extension has been requested and approved.

How does an employer request an extension?

The employer has to call CMS immediately at 1-855-798-2627 and request a 30 day extension. In general, extensions beyond the 60-day period (original 30 days plus one 30-day extension) will not be granted.

 Where can an employer get more information about the Data Match Project?

The letter received from CMS contains information as well as this website: https://www.cms.gov/medicare/coordination-of-benefits-and-recovery/employerservices/downloads/instructions-for-completing-the-group-health-plan-report-for-the-irs-ssa-cms-data-match.pdf

Does the Data Match Project only apply to employers that sponsor self-funded group health plans?

No. Any employer that sponsors a group health plan, whether fully insured or self-funded, can receive a Data Match Project request for information letter from CMS.

If an employer receives a letter, how do they respond?

Go to the website: https://www.cob.cms.hhs.gov/DataMatch/loginView.do. The employer will need to register and submit their completed questionnaire via this website.

What happens next?

After the employer registers and logs in through the website, they will be asked some questions about individuals with Medicare coverage who have been identified to Medicare as individuals who also have (or had) coverage through the employer’s group health plan. There will be questions designed to determine whether Medicare, which may have paid claims on behalf of some or all of these people, is the primary or secondary payer.

What happens if an employer does not respond to the letter?

CMS can impose a $1,000 penalty for every individual with respect to whom CMS has asked you for information. Additionally, if there are situations where the plan paid secondary to Medicare, when it should have paid primary (this is what CMS is trying to determine through the Data Match Project), there are stiff penalties that can apply. Employers whose health plans do not properly coordinate     benefits with Medicare face a number of penalties, including double damages for the amount of the claim, interest that begins to accrue within 60 days of the notice of the faulty payment, and a 25% excise tax.

For more information on Data Match Questionnaires please contact our Compliance Department.

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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.