The Centers for Medicare and Medicaid Services has released an updated Section 111 Model Language document dated March 10, 2021 (PDF version) for RREs to use as part of their efforts to obtain certain data points, including a claimant’s social security number or Medicare number, to assist in determining his or her Medicare beneficiary status. While CMS does not require RREs to use this Model Language document, in practice, many RREs utilize this document as part of their Section 111 data collection activities.
CMS’s revised Model Language document dated March 10, 2021 updates the agency’s prior version dated April 30, 2018. Overall, the updated Model Language document make various minor and non-substantive changes to the previous version.
From the authors’ review, these minor changes include:
- On the first page, CMS inserted a new Medicare card replica which has the sample Medicare number circled. Above the card, CMS added this verbiage “Please note the Medicare Number located on this card.”
- At the beginning of Section I, CMS removed a prior reference to “Part A or Part B” in the initial question regarding Medicare enrollment. In the prior version this question read, “Are you presently, or have you ever been, enrolled in Medicare Part A or Part B?” in the revised version, this question has been amended to simply read: “Are you presently, or have you ever been, enrolled in Medicare?” While it is unknown why CMS made this verbiage change, and without necessarily ascribing any particular significance to this update, by eliminating reference to “Part A or Part B” and making the question more general to reference being “enrolled in Medicare,” it is conceivable that CMS may have found that strict interpretation of the prior language may have been too limiting and that by modifying the question to be more general, may aid in obtaining responses from beneficiaries regardless of enrollment type.
- At the end of Section I, CMS expanded the verbiage in the ending note to read as follows (with the added verbiage in bold for the reader’s easy identification): “Note: If you are unable to provide your Medicare Number and uncomfortable with providing your full Social Security Number (SSN), you have the option to provide the last 5 digits of your SSN in the section ”
- In Section II, CMS removed the line for the claimant to enter his or her Medicare Number.
RREs using CMS’s Model Language should note these updates and the availability of this revised document for use as provided in the link above.
More globally, and beyond the scope of this article, the Model Language document raises the larger issue of efforts by RREs to obtain the relevant data points to determine Medicare status, noting that there have been some instances over the past several years where claimants have refused to provide this information. To address this, CMS, as part of its outstanding Section 111 civil money penalties proposals, is proposing a compliance safe harbor in instances where the RRE has not been able to obtain the necessary data points despite a “good faith” effort to do so. To learn more about CMS’s proposal, see FAQ #6 in our article CMS’s Section 111 penalty proposals – current status and FAQs.
Of course, please do not hesitate to contact the authors if you have any questions.