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Data Match Project Letter Puts Onus on Employers

06.01.2016

As Seen in BizTalk in the St. Louis Business JournalIf you are an employer that sponsors a group health plan, you might have recently received a letter from the Centers for Medicare and Medicaid Services (CMS) requesting that you submit the group health plan report for the IRS/SSA/CMS Data Match Project. Employers that receive this letter need to accurately complete the report within 30 days, or CMS may take the following actions:

  • Assess a civil monetary penalty of $1,000 for each person named in the inquiry for whom the employer has either not responded or provided incomplete information;
  • Subpoena business records and members of the organization to enforce compliance with the law; and
  • Investigate the employer’s group health plan (GHP) or large group health plan for a determination of nonconformance, and if so found, make a referral to the IRS for imposition of an excise tax on the employer.

Origin of Data Match Project

Long before Health Care Reform legislation, Section 6202 of the Omnibus Budget Reconciliation Act (OBRA) of 1989 was enacted to provide government agencies better information about Medicare beneficiaries’ GHP coverage. By regulation, the IRS, the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services are required to share information each agency has about Medicare beneficiaries and/or their spouses’ employment. The process for sharing this information is called the IRS/SSA/CMS Data Match.

The purpose of the Data Match is to help determine situations where other health insurance becomes primary to Medicare. The Data Match identifies employers of beneficiaries or spouses of beneficiaries for whom employer coverage, if available, is likely to be primary to Medicare. By adjusting when and if Medicare should pay claims, the Medicare Trust Funds have saved more than $3.5 billion.

Extensions and Benefits

Extensions for an additional 30 days to complete the requirement are available by request. Requests for extensions beyond 60 days (the original 30 days and one 30-day extension) generally are not granted to any employer that is reporting on fewer than 150 workers. If an employer has more than 150 workers, extensions will be reviewed on a case-by-case basis.

While the Data Match Project will prove burdensome to some employers, CMS believes the money saved and recovered through this project far outweighs the burden as follows:

  • Employers benefit because medical claims involving Medicare beneficiaries covered by group health plans are received and processed more quickly, which reduces administrative expenses and provides better services to covered individuals.
  • Covered Medicare beneficiaries benefit because their claims are processed correctly in the first instance. In almost all cases where Medicare is a secondary payer to a group health plan, the beneficiaries’ out-of-pocket expenses are lower than they would be otherwise.
  • The Medicare program benefits because Medicare makes fewer mistaken primary payments, which reduces trust fund expenses and the administrative cost of attempting to collect inappropriate payments.
  • Providers, physicians and other suppliers benefit because the total payments they receive for services provided to Medicare beneficiaries are greater when Medicare is a secondary payer to a group health plan than when Medicare is the primary payer.

If you are an employer that sponsors a GHP, this doesn’t mitigate the impact on you if you receive the CMS letter, however.

Ron M. Present, CALA, CNHA, LNHAIf you have questions about completing the questionnaire from CMS, click here to schedule a meeting or contact Ron Present, Partner and Health Care Industry Group Leader, at 314.983.1358 or rpresent@bswllc.com.

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