The Centers for Medicare and Medicaid Services (CMS) has discovered an issue with the Medicare Eligibility Query matching process when only a partial social security number (Last 5 digits) is provided. Partial social security number queries are a portion of the changes made to the Medicare reporting process with the enactment of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012.
When a Query is performed using a partial SSN, a positive match may be incorrectly returned in certain circumstances. If the queried individual and a known Medicare eligible individual have the same partial SSN and three of the remaining four fields are the same (first name, last name, date of birth and gender), then the two individuals will be matched and the response will indicate that the queried individual is Medicare eligible. In other words, a false positive is returned.
ExamWorks Clinical Solutions continues to recommend that the full SSN be obtained and used for the Medicare Query process as it greatly improves the accuracy of the Query and eliminates the possibility of false positive results.
We are analyzing the Query results received from CMS and will notify clients individually if their data is affected.
ExamWorks Clinical Solutions will continue to keep you apprised of updates to the Medicare Eligibility Query matching process as well as all relevant Medicare Secondary Payer compliance developments.
ExamWorks Clinical Solutions