Question of the Quarter: March 2016
What’s the Difference Between Section 111 Reporting and the Data Match Questionnaires from Centers for Medicare & Medicaid Services (CMS)?
Many employers are receiving Data Match Questionnaires directly from CMS. These questionnaires are separate from Section 111 and require employers to provide CMS with information regarding health coverage of specifically named employees—and their spouses—whom CMS believes are Medicare-eligible.
We’ve developed the chart below to help explain the differences between these requirements.
|Requirement||Purpose||Responsible Party||Potential Penalties|
|Section 111 Reporting||This reporting enables CMS to pay appropriately for Medicare-covered items and services furnished to Medicare beneficiaries by determining primary vs. secondary payer responsibility.||This requirement applies to the Responsible Reporting Entity (RRE).
Meritain Health, as the TPA of your group health plan, will submit production files to CMS to meet the reporting requirements.*
|The penalty for non-compliance on both Section 111 and CMS Data Match is $1,000 per member, per day that the information is not reported to CMS.
This means 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 Data Match Questionnaires||This questionnaire provides information to identify situations where another payer may be primary to Medicare.
Employers will report on workers who are entitled to Medicare or married to an individual who is a Medicare beneficiary.
|The data match requirement is an obligation of the employer/plan. Employers that receive a questionnaire should take the time to complete and the return the questionnaire to CMS.
Meritain Health will not complete or submit the report on behalf of the plan, but we will provide the information the plan/employer needs, upon request, to compete and file the report with CMS.
|The penalty is the same for both of these requirements. Please see above.|
* Please note, if you have other group health plans Meritain Health does not administer, a separate report must be submitted to CMS on the individuals enrolled in those plans. Therefore, it is possible Meritain Health may submit information on some of your members under the plan we administer, and those same members may be enrolled in another plan we do not administer, which would require dual reporting.
If you have any questions, please contact your client solutions team.
Compliance Corner is being provided as an informational tool. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this publication and any attachments, Meritain Health is not exercising discretionary authority over the plan and is not assuming a plan fiduciary role, nor is Meritain Health providing legal advice.