Ask ISM’s Health Care Reform Specialist

Vol. 14 No. 7

businessmanager eletter Vol14 No1 healthASK

Q: I received a legal-looking letter from The Center for Medicare and Medicaid Services (CMS) asking for information about a Medicare Beneficiary or Spouse. Is this letter legitimate, and do I have to do something with it?

A: The CMS did send out letters to certain companies and organizations. This letter originated from its Coordination of Benefits (COB) division. The letters are part of a data match—specifically the IRS-SSA-CMS Data Match—with the Social Security Administration (SSA), the Internal Revenue Service (IRS), and CMS working to identify Medicare participants who are also identified with an employer. This verification process is to ensure that medical claims are paid out correctly.

The process for you is not daunting, but does require some time. You can start the questionnaire and either complete it in one sitting or postpone completion if necessary, but it’s mandatory that you respond and complete before your given deadline. The initial timeline to respond is 30 days; failure to respond results in a fine of $1,000 per record requested.

When you receive the letter, it should name a website on which you must register, along with a pin number to identify you. The questionnaire is four parts and instructions are available here as a downloadable PDF.

Part 1 asks whether your school offers a health plan, and if the school employees 20 or more people for 20 or more calendar weeks. If you answer yes to either question, continue to Part II. The questionnaire then asks for specific details about your group health plan, and in Part III about the specific individuals identified in the data match between the SSA, the IRS, and CMS. The final part (Part IV) is your certification and guarantee that the information provided is correct.

The questionnaire asks about individuals, specifically if the people named worked during a specified period of time. If they were employed by the school in that time period, then the questionnaire asks whether they were under the employer’s group health plan at that time.

Curious about your school's health care policies and the reform's changes? Ask ISM’s Health Care Reform Expert a question. We respect your privacy. You can also view ISM’s health care solutions.

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