SHIBA | 800-562-6900 | July 2019 volunteer training | Page 1 of 36 Volunteer continuing education Statewide Health Insurance Benefits Advisors (SHIBA) Fraud, SMP and a STARS Tune up July 2019 Continuing Education Outline I. Learning aids and handouts II. Troubleshooting and sharing time III. Learning objectives IV. Fraud o What is fraud o Differences between fraud, errors and abuse o MSNs & EOBs and how it relates to this topic o What does this mean to you as a SHIBA advisor o Review and discussion of learning aids o Discussion of scenarios and “what to do if…” V. SMP o Introduction o Discussion of scam alerts o Volunteer endorsements VI. STARS tune up and job aids o Performance measures o STARS special instructions for MIPPA and SMP o STARS search tips VII. Discussion, demonstration and practice exercise VIII. Advanced study resources IX. Reminders and future training X. Continuing education evaluation Note: Acronyms and Advanced study resources available on My SHIBA. For volunteer training only – not for distribution
Transcript
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Volunteer continuing education Statewide Health Insurance Benefits Advisors (SHIBA)
Fraud, SMP and a STARS Tune up
July 2019 Continuing Education Outline I. Learning aids and handoutsII. Troubleshooting and sharing timeIII. Learning objectivesIV. Fraud
o What is fraudo Differences between fraud, errors and abuseo MSNs & EOBs and how it relates to this topico What does this mean to you as a SHIBA advisoro Review and discussion of learning aidso Discussion of scenarios and “what to do if…”
V. SMPo Introductiono Discussion of scam alertso Volunteer endorsements
VI. STARS tune up and job aidso Performance measureso STARS special instructions for MIPPA and SMPo STARS search tips
VII. Discussion, demonstration and practice exerciseVIII. Advanced study resources
IX. Reminders and future trainingX. Continuing education evaluation
Note: Acronyms and Advanced study resources available on My SHIBA.
For volunteer training only – not for distribution
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Learning aids and handouts • What is Medicare fraud and abuse? & How to Stop Medicare
Fraud ........................................................................................................................... P. 9-10 • Tips for clients to recover from a scam call .......................................... My SHIBA • Scam alert: Braces .............................................................................................. P. 13-14 • Job aid: STARS SHIP Performance Measures .......................................... P. 21-23 • Job aid: STARS Beneficiary Contacts MIPPA instructions ......................... P. 25 • Job aid: STARS Beneficiary Contacts SMP instructions ....................... P. 27-28 • Job aid: STARS search tips for Beneficiary Contacts ............................ P. 29-30 • Stop Medicare Fraud: Tips to keep you safe..................................... My SHIBA • Advanced study resources (in the July 2019 packet) ...................... My SHIBA
Troubleshooting and sharing time Share with your group any questions or information you have about the June topics and any local topics:
• Describe what we mean by person-centered counseling. Define ordescribe what the approach means.
• Describe the six phases of a person-centered counseling session.• Describe some communication techniques to interact effectively with
clients.• List and describe some techniques to deal with clients who exhibit
challenging behavior.• List some of the ways the Volunteer Handbook (VH) and Volunteer
Risk and Program Management (VRPM) provide guidance andexpectations when working with clients.
• Describe how Language Link can help with client counseling.• Explain what to do if you experience a safety incident with a client.
Local topics: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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INSTRUCTIONAL NOTES: Fraud Fraud points to cover
I. What is fraud
II. Differences between fraud, errors and abuse
III. Medicare Summary Notices (MSNs) & Explanation of Benefits (EOBs)and how they’re related to this topic.
a. Take a look at the May 2019 packet. RTCs: It may be helpful tohave a few copies on hand for reference.
b. MSNs
i. What is it?
1. MSNs are for Medicare beneficiaries who have PartsA & B with Original Medicare.
2. It's not a bill. It’s a summary of health care servicesand items Medicare beneficiaries received duringthe previous three months covered under MedicareParts A and B.
3. The MSN shows:
a. All the services or supplies that providers andsuppliers billed to Medicare during theprevious three-month period.
b. What Medicare paid.
c. The maximum amount the beneficiary mayowe the provider.
ii. When should someone get it?
1. Beneficiaries will get their MSN every three monthsif they get any services or medical supplies duringthat three-month period. If they didn’t get anyservices or medical supplies during that three-
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month period, they won’t get an MSN for that particular three-month period.
2. Beneficiaries can access this information online assoon as it’s available by setting up aMyMedicare.gov account at MyMedicare.gov.
iii. What should someone do if they get this notice?
c. Explanation of Benefits (EOB)
i. What is it?
1. EOBs are for both Medicare Advantage and stand-alone drug plans.
2. Each month when a beneficiary fills a prescription orgets health care, their Medicare Prescription DrugPlan (PDP) or Medicare Advantage (MA) plan mailsthem an Explanation of Benefits (EOB). This noticegives them a summary of their claims and costs.
ii. When should they get it?
1. Monthly (If they received care or prescriptionsduring that month).
iii. Who sends it?
1. Their plan.
iv. What should they do if they get this notice?
IV. What does this mean to you as a SHIBA counselor?
V. Review and discussion of learning aids on next pages
a. Learning aid P. 9: Review and discuss What is Medicare Fraudand Abuse / Help Stop Medicare Fraud. NOTE: This learning aidis SMP information. SHIBA’s Stop Medicare Fraud: Tips to keepyou safe handout is for clients and is available atwww.insurance.wa.gov/sites/default/files/documents/stop-medicare-fraud.pdf.
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b. Learning aid P. 11: Tips for clients to recover from a scam call
c. Discussion option: Scam Alert: Braces P. 13
VI. Fraud discussion of scenarios and “what to do if…”
a. What to do if you suspect errors or fraud
b. Take some time to discuss these questions or any others youcan think of.
i. Scenarios discussion
1. What to do when you get the call from a client thatsays, “I’m the victim of some kind of fraud.”
2. What to do and how to transform a panicked callinto a guided counseling session about an eventthat occurred.
3. What do I do if something happens?
ii. Suggestion: Maybe come up with a script of questions toask. Use scenarios to help with the questions to ask.
iii. Use some specific examples. To create some essentialquestions:
1. Who sent the letter?
2. Can you read it to me?
iv. Provide concrete steps and examples about what to do incertain situations such as:
1. A consumers calls that they got a bunch of backbraces sent to them.
2. Or calls to say they got a call that they were goingto get cut off from Medicare so what to do.
3. When someone receives a robocall.
4. DME calls. Examples and what to do.
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v. Have some actual examples and stories and theoutcomes. The SMP resource center has some examplesi.e. the DNA/genetic testing scheme and the braces scam.
vi. Suggestions
1. Use Medicare Minute materials and SMPdocuments. Find links in the Advanced studyresources section of this packet starting on P. 32under Medicare Minute (links are in the packet onMy SHIBA). Search smpresource.org underResources for “durable Medical Equipment fraud &Abuse” to locate the script, teaching materials, andhandout.www.smpresource.org/ResourceLibrary/Resources/1B66C791-2A6B-4C51-B6AD-CBAE2BE5379A/Medicare-Minute-SMP-targeted-edition-May-2019-Durable-Medical-Equipment-Fraud-Abuse.aspxNote: you may need to copy and paste this linkinto your browser.
2. Durable Medical Equipment Fraud and Abuse: Whatmight DME fraud, errors and abuse look like?
3. Medicare Minute Teaching Materials – May 2019:Durable Medical Equipment Fraud and Abuse. Seelink from the Advanced study resources section inthis packet which is available on My SHIBA.
Medicare Fraud occurs when a person or company knowingly tricks Medicare.
They do this intentionally to receive inappropriate payment from the program.
Medicare Abuse occurs when providers seek Medicare payment they don’t
deserve but they have not knowingly or intentionally done so. Abuse can also involve billing for unsound medical practices.
What is the difference?
The main difference between fraud and abuse is intent – did they do it knowingly or not? Only the authorities may be able to answer that question. Whether it is fraud or abuse, it still wastes billions of dollars every year. It needs to be reported.
Examples of Fraud and Abuse
Billing for services, supplies, or equipment that were not provided
Calling Medicare beneficiaries and asking for their Medicare number, sayingit is needed to get a new Medicare card or keep their Medicare benefits
Trying to get a Medicare number in exchange for “free” services
Billing for services different than what was provided (to get a higherpayment)
Billing for medically unnecessary services or supplies
Billing for excessive medical services or supplies
Medicare Fraud and Abuse Affects Everyone
Medicare loses billions of dollars to improper claims every year. This affects everyone by wasting billions of taxpayer dollars. This also affects YOU. False information can end up on your medical records, leading to improper medical care later. You may even be denied services you need and deserve.
What Is Medicare Fraud and Abuse? Tips for Protecting Yourself and Medicare
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Funded by the U.S. Administration for Community Living (ACL), Administration on Aging (AoA),
Grant Number 90NP0001
Help Stop Medicare Fraud
DO:
Ask questions. You have the right to know everything about your care,including how much it costs.
Keep a record of the dates of Medicare services received. Using yourPersonal Health Care Journal (available from your local SMP) is an idealway to do so.
Report suspected instances of fraud, such as to your local SMP.
Review your Medicare Summary Notices (MSNs) and Explanations ofBenefits (EOBs):
Did you receive the service or the product?
Did your doctor order this service or product?
Were you billed for a service or product more times than youreceived it?
Were the services on your statement related to your condition?
DON’T:
Don’t give out your Medicare number to anyone who asks. Only yourdoctor or your other Medicare providers should need it.
Don’t give your Medicare number to telephone callers or door-to-doorsolicitors.
Don’t accept “free” medical services in exchange for your Medicare orSocial Security number.
How Your Senior Medicare Patrol (SMP) Can Help
Your local SMP is ready to provide you with the information you need to PROTECT yourself from Medicare error, fraud, and abuse; DETECT potential error, fraud, and abuse; and REPORT your concerns. SMPs use trained senior volunteers to help educate and empower seniors in the fight against health care fraud. Your SMP can help you with questions, concerns, or complaints about potential fraud and abuse issues. It also provides information and educational presentations.
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Tips for clients to recover from a scam call
Have your clients ever given their personal information out over the phone? Remind them it’s best to not answer the phone unless they know who is calling. If it’s important, the caller will leave a message. However, if they should give out personal information, tell them to follow these steps immediately:
Call their bank if they gave out their account information. They may want to considerchanging their accounts altogether.
Call SHIBA at 1-800-562-6900 to report health care fraud, waste or abuse. SHIBA sharesthe scam details with seniors across the state, and with programs in other states, to helpwarn people before they can become a victim.
Call 1-800-MEDICARE and let them know their Medicare card number has beencompromised if they gave it out. With the new cards it’ll be as simple as cancelling one andgetting a new one issued. They’ll also need to inform their medical providers so they don’tuse the old number.
Contact the Federal Trade Commission:o Identity Theft Helpline: 1-877-ID-THEFT (1-877-438-4338); TTY: 1-866-653-4261o Email: [email protected] to forward unsolicited commercial email (spam), including
phishing messages. These messages will be stored in a database that law enforcementagencies use in their investigations.
Note: the Federal Trade Commission (FTC) does not resolve individual consumer complaints.
File a police report. The report only needs to be made if personal information, such as theircredit card, social security number, or routing numbers were given out OR they experienceda money loss by sending a check or wiring money through Money Gram or Western Union.
The police report contains specific details of an identity theft and is considered an IdentityTheft Report under section 605B of the Fair Credit Reporting Act (FCRA). It entitles anidentity theft victim to certain important protections that can help them recover morequickly from identity theft down the road.
Place a fraud alert or freeze on their credit reports, and review their credit reports. Afraud alert or freeze can help prevent an identity thief from opening any more accounts intheir name. If they gave out their social security number, they need to call the toll-freefraud number for any of the three consumer reporting companies below to place a fraudalert on their credit report. The company they call is required to contact the other twocompanies. A fraud alert will last 90 days, while a freeze lasts until your client lifts it.
Consumers can receive a free credit report from each of the three companies once a year. Requesting from one of the companies every four months enables consumers to look at their reports three times a year for free. Once consumers get their credit reports, they should look for inquiries from companies they didn’t contact, accounts they didn't open, and debts on their accounts they can't explain. They should check that information, like their Social Security number, addresses, name or initials, and employers, is correct. If they find fraudulent or inaccurate information, they need to get it removed. If they just gave out their information, likely it will not show up right away. Often times the information is kept for a year or two before using so people are likely to quit worrying about it and let their guard down. They should always check their credit report.
If client did NOT give out a personal information, but received a scam call
Clients do not need to call their bank, etc. However, they should follow these steps any time they answer a robocall or other telemarketing call:
Hang up. The longer they stay on the line, the more attractive they are for them to callagain and to sell their number to other lists. If possible, don’t pick up the phone when ifthey don’t know who is calling. By answering they’re telling the caller they’re a live line andthey’ll keep them on rotation. By not answering the phone, the client will eventually dropoff their call lists.
Block the number. Most cell phones make this easy, and though telemarketers change theircaller ID information often, blocking numbers will still help stop some of the calls.
Sign up for the Do Not Call list. Since only reputable businesses will follow the law, this tellsthem that those who continue to call are scammers. If they get a sales call after theirnumber’s been on the list for 31 days, complain to www.donotcall.gov or call 1-888-382-1222.
Report their experience to the FTC at www.ftccomplaintassistant.gov or by calling 1-888-382-1222.
For more information, go to dojmt.gov/consumer/identity-theft/.
Note: SHIBA is in the process of printing a similar fact sheet geared towards clients and will let us know when it’s available for ordering through Fullfillment.
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SCAM ALERT: Braces
Durable Medical Equipment has been an area ripe with fraud for many years. The SHIBA Senior Medicare Patrol (SMP) is seeing many cases where clients on Medicare are receiving braces (ankle, back, knee and neck) from out-of-state providers. Doctors or other providers who the client has never heard of or seen are ordering these braces.
Some of these scams are promoted through tv ads for braces that are “covered by Medicare.” Others occur through phone calls and postcards. Remind your clients to NOT fall for these scams! Their doctor knows if they need medical care or equipment. Only a medical professional familiar with someone’s medical needs should be prescribing equipment, not some unknown doctor from another state.
If clients become a victim of this type of fraud, take the following steps:
1. Follow the SHIBA job aid for STARS Beneficiary Contacts SMPinstructions, which you can find on My SHIBA. After you complete theSTARS BC form, SHIBA will then report the suspected fraud to the U.S.Office of Inspector General (OIG) for investigation. When completingthe STARS information, be sure to include the name, address andphone number (if known) of the company that sent the brace(s).
2. Tell the client to contact the company that sent the items to getinformation about returning the items. The client should ask for apostage-paid return label, as there should be no cost to the sender.
3. If clients return the item, make sure they get a receipt for the returnand a tracking number to monitor delivery of the item. Keep a copyof the receipt and the tracking notice when the supplier’s received theitem.
Continued on back
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4. Tell the client to check their Medicare Summary Notice (MSN) to seethe name of the doctor who ordered the braces and be sure to sharethis information with SHIBA.
5. Tell the client to NEVER give out their Medicare, Social Security, bankor credit card numbers to someone they don’t know and for servicesnot ordered by medical providers they trust.
6. If a client mistakenly gave their NEW Medicare number to a scammer,call 1-800-MEDICARE (800-633-4227) to report the theft and requesta new Medicare number. If they gave their old Medicare number,which includes a Social Security number, call the FTC Identity Thefthelpline at 877-ID-THEFT (877-438-4338).
SHIBA is Washington state’s Senior Medicare Patrol (SMP) project. We can help clients prevent, detect and report
Medicare and Medicaid fraud and abuse.
To report a scam or potential fraud, call SHIBA at 1-800-562-6900.
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INSTRUCTIONAL NOTES: Senior Medicare Patrol (SMP)
I. SMPa. Introduction
b. SMP: Protect, Detect, Report
c. Knowing what fraud and abuse are—and the differencebetween the two—is crucial, and educating people is critical toour mission. As SHIBA advisors, we’re more effective if we canhelp clients understand what a fraudulent activity is. We mayneed to counseling and educate clients around how the healthcare system and billing works, and how to read Medicarestatements.
d. There is a lot of Medicare fraud and abuse going on in WAtargeting seniors. Scammers can potentially bilk our consumersout of a lifetime of savings and health benefits.
e. SMP is a federal program that funds SHIBA to educateconsumers, caregivers and families about Medicare fraud abuseand errors.
II. Discussion of scam alerts
a. Such as braces and genetic testing as it relates to SMP: Protect,Detect, Report.
b. Other scam information may be found in the Advanced studyresources of this packet.
c. This will be a “what to do” for the volunteers.
III. Volunteer endorsements
a. Not all volunteers have taken the SMP training.
b. All volunteers should provide information to clients based ontoday’s training
c. Add the MATRIX from page 17 into this messaging.
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d. All volunteer advisors are eligible for SMP endorsement and weencourage them to continue training from the SMP resourcecenter and become SMP-endorsed.
e. RTC suggestion: Have a one-page introduction about whatSMP is and how it dovetails with our SHIBA work, and how allvolunteers have the opportunity to be certified. NOTE: You mayrefer to the SMP Foundations Training Manual Chapter 1 page 3as a source. Search smpresource.org (login required) underResources for “SMP foundations training manual.”
f. The SMP Training Matrix on page 17 shows the roles in ourstate’s SHIBA program and what trainings volunteers shouldtake specific to the role/job description volunteers and othershave within the program.
g. Volunteers may contact their RTC or Judith Bendersky([email protected]) for more information.
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Senior Medicare Patrol (SMP) volunteer training matrix The matrix below shows the roles in the Washington SHIBA program and what trainings volunteers should take specific to the role/job description they and others have within the program.
Anyone who passes SMP Foundations, SMP Counselor training and SMP Group Outreach and Education is considered SMP-endorsed and receives a certificate. SMP-endorsed volunteers are invited to participate in monthly national mentor calls to learn and share with others in the U.S.
We encourage all volunteers to integrate their SMP knowledge into their SHIBA counseling and community outreach to continually raise awareness about detecting and reporting Medicare fraud.
Role Foundations Group Education
SMP Counselor
Complex Interactions
Info distributor X Admin support aid
X
Exhibitor X X** X*** VC’s X Presenter X X X*** Counselor (any certified volunteer advisor)
X X
SMP Endorsed Volunteer
X X X optional
** For the exhibitor role, Chapter 1 of the SMP Group Education Training Manual and the appendices are recommended.
***For the exhibitor and presenter roles, Chapter 1 of the SMP Counselor Training Manual and the appendices are recommended.
Contact a SHIBA Regional Training Consultant or [email protected] for more information.
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INSTRUCTIONAL NOTES: STARS tune up
I. STARS tune up
a. Learning objectives:
i. Explain what to do in STARS to help meet performancemeasures
b. STARS message:
i. What counts
ii. How do we do this and why
iii. What to do
iv. Don’t forget to do it
v. Here’s what it looks like
1. Show in training how it looks (RTCs can present on acomputer)
II. Job aid: STARS SHIP Performance measures P. 21:
a. Focus on two or three of these including hard-to-reachpopulations or collecting income.
b. Here are the five performance measures and how they count.How to meet our contractual benchmarks, tiers, low-income,non-English speaking LEP and a couple others. Build it into yourquestion routine.
i. PM1: Client Contacts - Percentage of total client contacts(in-person office, in-person home, telephone [alldurations], and contacts by e-mail, postal, or fax) perMedicare beneficiaries in the state
ii. PM2: Outreach Contacts - Percentage of people reachedthrough presentations, booths/exhibits at health/seniorfairs and enrollment events per Medicare beneficiaries inthe state.
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iii. PM3: Medicare Beneficiaries Under 65 - Percentage ofcontacts with Medicare beneficiaries under the age of 65applying for or receiving SSDI.
iv. PM4: Hard-to-Reach Contacts - Percentage of low-income, rural, and non-native English contacts per total“hard-to-reach” Medicare beneficiaries in the state.
v. PM5: Enrollment Contacts - Percentage of unduplicatedenrollment contacts (i.e., contacts with one or morequalifying enrollment topics) discussed.
III. Job Aid: STARS Beneficiary Contacts MIPPA instructions P. 25
a. MIPPA information from Liz Mercer via email 3/28/19: “Werecently learned on a Webinar about data for MIPPA that whenwe actually help a person to submit an application for LISand/or MSP, we need to check the box that says “ApplicationSubmission.” (That would be in addition to marking the MIPPA“Yes” button at the very top of the BC.)
IV. Job aid: STARS Beneficiary Contacts SMP instructions P. 27
a. SMP – Review the Beneficiary Contacts SMP instructions job aidwith volunteers.
V. Job aid: STARS search tips for Beneficiary Contacts P. 29
a. Review of the STARS search tips for Beneficiary Contacts job aidand instructions of why and how searches are used.
b. Discuss and answer any questions about searches. Mostvolunteers don’t need unless wanting to look up a record of aprevious contact with a client.
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STARS SHIP performance measures job aid SHIBA job aid
SHIBA has five performance measures as part of our National SHIP funding from the ACL (Administration on Community Living). Following is how they are documented in STARS.
1. Client ContactsHow documented:All Beneficiary Contact forms (BC’s) and Additional Beneficiary Contact formsreported on one-on-one interactions where Medicare or SHIBA programinformation is shared with or on behalf of beneficiaries.
Includes Does Not Include In-person counseling Unsuccessful attempts to reach a
beneficiary (i.e. leaving a message) Telephone Individuals reached through public
events (unless you have substantial individual contact with someone after
the event) Email
Postal mail Contacts when the only purpose is to schedule an appointment
Fax Mass emails Web-based
2. Outreach ContactsHow documented:Number of people reached (attendees) through events reported on GroupOutreach and Education Forms.
• The event must include the provision of Medicare or SHIP information tothe public.
• People reached requires the ability to monitor attendance and offers anopportunity for participants to ask questions at the time of thepresentation.
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Includes Does Not Include Presentations (in-person,
webinars, teleconferences) Billboards Radio
Email Social Media Booths and exhibits Magazine/Newspaper Television Enrollment Events Newsletter Website
3. Medicare Beneficiaries Under 65How documented:All Beneficiary Contact forms and Additional Beneficiary Sessions, whichindicate the beneficiary is BOTH under age 65 AND receiving or applying forSocial Security Disability or Medicare Disability.
AND
4. Hard-to-Reach ContactsDocumented three ways:• Low-Income – Below 150% Federal Poverty Level
• Rural Contact – Based upon Zip Code of Beneficiary Residence in STARS.
• Non-Native English speakersa. If client answers “no” to the question “Is English your first language?”ORb. If the counselor can reasonably conclude that the client is not fluent
in understanding, speaking, reading, and/or writing the Englishlanguage.
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5. Enrollment ContactsHow documented:Total unduplicated enrollment contacts as reported by checking one or moreof the following Topics Discussed on Beneficiary Contact forms and AdditionalBeneficiary Sessions.
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STARS Beneficiary Contacts MIPPA instructions SHIBA job aid
Updated MIPPA Beneficiary Contact instructions
MIPPA field defaults to “No.” Change to “Yes,” when you can check any appropriate box(es) in Topics Discussed.
Qualifying MIPPA Topics Discussed Part D Low Income Subsidy (LIS/Extra
Appeals/Grievances Claims/Billing Ambulance Hospital Claims/Billing Fraud and abuse Dental/Vision/Hearing New Medicare card
DMEPOS Preventive benefits
Home health care Skilled Nursing Facility Hospice
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SMP Complex Cases instructions
“Complex Cases” is a Senior Medicare Patrol (SMP) term for possible fraud or abuse cases that may need further action, documentation or reporting, such as:
• Suspected fraud, errors or abuse that could result in cost-savings or refundsto clients, providers, Medicare, Medicaid
• Suspected fraud by:o Health care providerso DME provderso Pharmacieso Insurance agents and brokers
• Suspected Part C or Part D marketing violations• Possible compromised Medicare number
Any SHIBA volunteer can help with reporting. These cases will be flagged for review and possible action by the SHIBA Complaints Resolution Coordinator if you take the following steps:
1. Choose Send to SMP on the Beneficiary Contact Form.2. Document in the NOTES section of the STARS Beneficiary Contact any
information that:o States that the client, providers, Medicare or Medicaid could
experience cost savings, AND there are documents available todemonstrate this. Examples: Bills, MSNs, EOBs, copies of checks, letters, etc.
OR o States that the client has documents available to demonstrate a case
of suspected fraud, errors or abuse. Examples: Shipping labels, bills, MSNs, EOBs, letters, etc.
3. The SHIBA Complaints Resolution Coordinator will run a report in STARS thatwill locate these cases. Additional action will be taken as appropriate.
4. Notify the client they might be contacted for further information or to collectcopies of documents.
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STARS search tips for Beneficiary Contacts SHIBA job aid
Your ability to search is based upon your role (level of access) in STARS. You can search within your own organization and at your access level and below. Most SHIBA volunteers are “Team Members,” which means they should be able to search for Beneficiary Contacts (BC) entered by their fellow Team Members within their organization.
1. From your Home page, click in the red “Search” tab. A new page will openup.
2. Under “Beneficiary Contact,” click on “Standard Search.”These instructions will give tips on searching by the SHIP Reference Number(BC Number), Beneficiary’s name, or Beneficiary’s phone number. You canuse the same steps to search for any field collected in a BC. It is best to onlysearch by only one or two fields at a time.
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3. Click in the box next to “Beneficiary Contact.” A new page will open up.
4. Complete the field you’re searching for - recommended just one or two fieldsper search.
• SHIP Reference Number (BC Number): Type the whole number, withno spaces into the “SHIP Reference Number” space. Example: WA-19-1975961
• Beneficiary Phone Number: Type the 10-digit phone number. Youneed to add the dashes. Example: 206-555-5555. Screen snip belowshows a phone number search.
• Beneficiary First Name, Beneficiary Last Name: Type in the field,remember that other entries may have spelled the name differently.
5. Click on the blue “Search” button, and your BC’s should show up.
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INSTRUCTIONAL NOTES: Discussion
These discussion options may be presented as a discussion, demonstration or practical exercise.
• Identify what our performance measures are for STARS. How do youhelp meet them? Remember that it’s based on the boxes you checkand is tied to funding.
• Describe ways to collect different types of data in STARS and how tobest deal with adding data rather than checking “not collected.”
• Detailed discussion of asking demographic questions for the JulySTARS Tune-up session
• Tips on collecting demographic info.
• How to ask questions. Role play.
• Use the Medicare Minute Counseling Tips on Durable MedicalEquipment Fraud and Abuse. The links are available in the Advancedstudy resources section of this packet on My SHIBA.
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INSTRUCTIONAL NOTES: Advanced study resources These resources are supplemental to this month’s topic and provide more in-depth content and information. The links are accessible from the electronic version of this training packed located on My SHIBA.
Durable Medical Equipment Fraud and Abuse portal.shiptacenter.org/media/4821/mm-smp-targeted-may-2019-counseling-tips.pdf
Explanation of Benefits (EOB) www.medicare.gov/forms-help-resources/mail-you-get-about-medicare/explanation-of-benefits-eob
Help fight Medicare fraud www.medicare.gov/forms-help-resources/help-fight-medicare-fraud
How do I file and appeal? www.medicare.gov/claims-appeals/how-do-i-file-an-appeal
How to Recognize a Robocall www.aarp.org/money/scams-fraud/info-2019/recognize-a-robocall.html
Illinois 2019 SHIP Training Manual for New Counselors From the SHIP TA site, requires login portal.shiptacenter.org/resource-published/r1/illinois-2019-ship-training-manual-for-new-counselors/
Making Sense of Your Medicare Statements www.insurance.wa.gov/sites/default/files/documents/medicare-statements-msn.pdf
Medicare: Information in other languages www.medicare.gov/about-us/information-in-other-languages
MyMedicare.gov Help www.mymedicare.gov/helppages/gettingstarted/
Part A: What is New on Your Redesigned Medicare Summary Notice? www.medicare.gov/sites/default/files/2018-07/summarynoticea.pdf
Part B: What is New on Your Redesigned Medicare Summary Notice? www.medicare.gov/sites/default/files/2018-07/summarynoticeb.pdf
Scam Alert: Braces, Iowa SMP Check for it in the Resource Libraries, requires a login www.smpresource.org/ResourceLibrary/Resources/18889616-B234-4F30-898C-5605ECAB68B5/Scam-Alert-Braces.aspx
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Reminders and future training
Training Evaluation Please fill out the training evaluation. We value your feedback!
2019 and 2020 training
Training topics are subject to change.
Content ideas If you have ideas, include them on your evaluation form and return it to your RTC.
We are working on an instructional acronym page. It will be located on My SHIBA with the CMS Frequently Used Acronyms document. Search My SHIBA for “acronym.”
August No training September Open enrollment October How to afford drug costs November Accessing supplemental benefits December No training January 2020 Welcome to 2020 February TBD March TBD April Volunteer Recognition, topic TBD May TBD June TBD
SHIBA | 800-562-6900 | July 2019 volunteer training | Page 36 of 36
Continuing education evaluation
Date of Training: _______________ Training Location: ______________________ How can SHIBA improve the monthly trainings? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What additional trainings within our SHIBA scope would you like to see? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What SHIBA training materials — including Quick Reference Cards (QRCs) — would you like to see added to My SHIBA? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Other: _________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Optional: If you would like to be contacted, please provide your name and contact information. Someone in our office will contact you. Thank you! Name: ________________________________________________________________________ Day Phone: ________________________Email: ____________________________________ If you prefer to give electronic feedback about curriculum or training, please contact: Diana Schlesselman: [email protected] or Liz Mercer: [email protected].
