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As part of the ongoing efforts of the Centers for Medicare/Medicaid Services ("CMS") to cut costs, CMS has been sending "Data Match" letters to employers who have employees (or spouses of employees) who are eligible for Medicare. In these letters, CMS states that since 1989, Medicare has been attempting to identify situations in which another health care plan should be the primary payer for a Medicare beneficiary's health services. Whenever CMS notices that an employer has an employee or a spouse of an employee who is eligible for Medicare, CMS will send a "Data Match" letter requesting information that will help CMS identify whether Medicare will be the primary payer for the individual's health services.

Employers must respond to "Data Match" letters by completing an online questionnaire. The questionnaire and detailed information may be accessed at https://www.datamatch.cms.hhs.gov. An employer's Employer Identification Number ("EIN") and Personal Identification Number ("PIN") will be printed on the CMS Data Match letter, and these will be needed to log in to the Data Match website. Before beginning the questionnaire, employers must register an Account Manager to serve as the primary individual responsible for completing the Data Match questionnaire. The Account Manager may then delegate other individuals to serve as Designees, who can assist with the data entry process. The actual data requested by CMS will vary across employers, but the questionnaire will typically require information concerning the employer's Group Health Plan and individual employees' eligibility for Medicare.

The law requires that employers respond to "Data Match" letters within 30 days. Employers may request an additional 30 days to complete the questionnaire in order to gather the required information. If employers do not complete the questionnaire within the allotted time frame CMS can impose a fine of $1,000 per Medicare-eligible employee.

If you receive such a letter, you should immediately begin the process of gathering and entering the requested information. This will be a burden on employers, but it is required by law, and the penalties for tardiness or failure to comply are substantial.

Should you have any additional questions regarding CMS Data Match issues, contact Kenny W. Keith in our Health Care Group.