The CMS Data Match game, that is. That’s right, ladies and gents, the Centers for Medicare and Medicaid Services (CMS) has kicked off a new Medicare Data Match game. Employers everywhere are receiving letters from CMS asking them (the employers) to provide eligibility and coverage information, under the employers’ group plans, related to certain Medicare-enrolled individuals.
Employers have all kinds of questions about these letters.
Q: Do I have to do anything with these letters?
A: Yes. Ignoring an information request from federal authorities rarely ends well.
Q: Alright. But haven’t I already done this? Doesn’t this pertain to that annual Medicare Part D filing I do online, through the CMS website?
A: Nope. This is different. The Data Match game is played when Medicare wants to confirm that claims it is paying on a primary basis should in fact be paid on a primary basis, as opposed to paying on a secondary basis, after an employer group plan pays the claim first.
To determine this, Medicare 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.”
Q: Tell me more about this Data Match game!
A: Gladly. Here is how Medicare describes it (the emphasis is ours):
Reporting Requirements of Data Match
Employers must provide CMS with 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 GHP [group health plan] coverage. Employers must respond within 30 days of the initial inquiry, unless an extension has been requested and approved.
Q: Where can I get more information about this exciting Data Match game?
A: Instructions for playing the game are available through CMS.
Q: Does it matter whether my health plan is insured or self-insured? Do I need to play the Data Match game either way?
A: No, it does not matter. Yes, you must play the game either way.
Q: Can someone do this for me? Can I share the fun?
A: It’s possible for you to designate an authorized representative to handle this for you, assuming the representative has access to the relevant information. Some third-party administrators do this for their self-insured plan clients, typically for a fee.
Q: How much time do I have to answer CMS’s questions?
A: Generally, 30 days.
Q: I can’t wait another minute! How do I get started?
A: If you’ve received such a letter from CMS, please click to get started.
Q: What can I expect to see there?
A: Once you register and log in through the website, you’ll be presented with some questions about individuals with Medicare coverage who have been identified to Medicare as individuals who also have (or had) coverage through your 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.
Q: Is the Data Match game new?
A: No, this is a relatively standard process…CMS has been doing this for many years. These inquiries of employers are sent out in batches from time to time.
Q: Who is the real winner of the Data Match game?
A: Federal taxpayers and Medicare enrollees. Money that Medicare recovers, from situations where Medicare has paid primary when it should have paid secondary, help shore up the Medicare coffers.
Q: What if I don’t want to play, and just don’t respond to the letter?
A: We don’t advise that. CMS can impose a $1,000 penalty for every individual with respect to whom CMS has asked you for information, and you fail to reply.
In addition, if there are situations where your plan paid secondary to Medicare, when it should have paid primary (this is what CMS is trying to figure out, through the Data Match game), there are stiff penalties that can apply. Last we looked, 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 percent excise tax.