What’s the difference between Section 111 and the Data Match Questionnaires from CMS?

There has been a lot of hype this year around the mandatory Medicare Secondary Payer (MSP) reporting requirements that went into effect January 1, 2009. These new reporting requirements apply directly to the Responsible Reporting Entity (RRE), which is either an insurance carrier, third party administrator (TPA) or, in rare cases, the plan administrator of employer-sponsored group health plans that are both self-funded and self-administered. Please refer to our previous article on Section 111, from our July 2009 Compliance Quarterly, for more detailed information. 

As the TPA of your group health plan, Meritain Health has already begun submitting files to the Centers for Medicare and Medicaid Services (CMS) to meet these new reporting requirements. (If you have other group health plans that Meritain Health does not administer, a separate report must be submitted to CMS on the individuals enrolled in that Plan. Therefore, it is possible that Meritain Health may submit information on some of your members under the ABC Company Employee Benefit Plan  and those same members may be enrolled in another plan that would require dual reporting.) Many of you have responded to the request from your Client Relationship Manager (CRM) to provide us with required data elements on certain active covered individuals. If you have not already responded to our request for this information, please do so as soon as possible. 

The penalty for non-compliance is steep. It is $1,000 per member per day that the information is not reported to CMS. This means that for a group that is missing social security numbers on ten individuals, the penalty would be $10,000 per day and if it takes 30-days to gather the information, the total penalty that could be assessed would be $300,000. 

CMS has indicated that they will work with those who are demonstrating a good-faith effort. If you are unable to provide all the requested information all at once, please contact your CRM to discuss alternative arrangements for submitting this information.

Additionally, many employers have been receiving Data Match Questionnaires directly from CMS. These questionnaires are separate from the Section 111 project and require information regarding health coverage of specifically named employees and their spouses whom CMS believes are Medicare-eligible. 

We believe that the mandatory reporting requirement added under Section 111 was designed to curtail or even eliminate the Data Match Questionnaire in the future. In the meantime, employers that receive a questionnaire should take the time to complete and the return it to CMS. Like the penalty for non-compliance with Section 111, an employer that willfully or repeatedly fails to comply will face civil monetary penalties of $1,000 per individual. In addition, CMS has the power to subpoena business records and members of your organization to enforce compliance, and the IRS has the power to impose an excise tax. 

For more information on the Data Match Questionnaire, please visit the CMS Web site. 

For more information, click here to listen to our podcast on Section 111.