Upload
leo-fleming
View
218
Download
0
Embed Size (px)
DESCRIPTION
According to a Senate report, these make up the best front line defense against loss from health care fraud and abuse. Return to Board See Question $200
Citation preview
SMP SMP JEOPARDY!JEOPARDY! The Administration on Aging Community’s The Administration on Aging Community’s
Favorite Quiz ShowFavorite Quiz Show
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
About SMPs About SMPs MedicareMedicare OverviewOverview
Medicare Medicare Programs Programs
Fraud Fraud and and
AbuseAbuse MiscellaneousMiscellaneous
According to a Senate report, According to a Senate report, thesethese make up the best make up the best front line defense against front line defense against loss from health care loss from health care
fraud and abuse.fraud and abuse.
Return to Board See Question
$200
Question:
Return to Board
What are What are senior citizens?senior citizens?
$200
Return to Board See Question
The acronym AoA The acronym AoA stands for stands for thisthis agency, agency, which funds the SMP which funds the SMP
program. program.
$400
Question:
Return to Board
What is the What is the Administration on Aging? Administration on Aging? (an agency of the U.S. (an agency of the U.S.
Department of Health and Department of Health and Human Services) Human Services)
$400
Return to Board See Question
TheseThese are the are the twotwo agencies to which agencies to which
SMPs report their SMPs report their performance data.performance data.
$600
Return to Board
Question: What are What are
1.1. The Administration on The Administration on Aging (AoA), andAging (AoA), and
2.2. The Office of the Inspector The Office of the Inspector General (OIG)?General (OIG)?
$600
Return to Board See Question
SMPs enter data into SMPs enter data into thisthis computer database, computer database, which then is reviewed which then is reviewed
by AoA and the OIG.by AoA and the OIG.
$800
Return to Board
Question:
What is SMART FACTS?What is SMART FACTS?
$800
TheseThese are are threethree of the of the five AoA SMP strategic five AoA SMP strategic
program objectives.program objectives.
Return to Board See Question
$1000
Return to Board
$1000Question: What are What are 1.1. Foster national and statewide program Foster national and statewide program
coverage;coverage;2.2. Improve beneficiary education and inquiry Improve beneficiary education and inquiry
resolution;resolution;3.3. Foster national program visibility and Foster national program visibility and
consistency;consistency;4.4. Improve the efficiency of the SMP program Improve the efficiency of the SMP program
while increasing results; andwhile increasing results; and5.5. Target training and education to isolated and Target training and education to isolated and
hard-to-reach populations? hard-to-reach populations?
Return to Board See Question
Medicare, a federally Medicare, a federally funded program, was funded program, was
created by Congress created by Congress in in thisthis year. year.
$200
Return to Board
Question:
What is 1965?What is 1965?
$200
Return to Board See Question
$400
Individuals who are eligible Individuals who are eligible for both Medicare and for both Medicare and
Medicaid are called Medicaid are called thisthis..
Return to Board
Question:
$400
What are dual-eligibles? What are dual-eligibles?
Return to Board See Question
ThisThis is a Web site that is a Web site that SMP volunteers should SMP volunteers should
encourage encourage beneficiaries to sign up beneficiaries to sign up
for and use.for and use.
$600
Question:
What isWhat iswww.MyMedicare.gov?www.MyMedicare.gov?
$600
Return to Board
Return to Board See Question
ThisThis is the full name of is the full name of the agency responsible the agency responsible
for administering the for administering the Medicare program.Medicare program.
$800
Return to Board
Question:What is the Centers for What is the Centers for
Medicare & Medicaid Medicare & Medicaid Services (CMS)? Services (CMS)?
$800
Return to Board See Question
ThisThis type of Medicare type of Medicare enrollment is for individuals enrollment is for individuals
who have been receiving who have been receiving Social Security benefits or Social Security benefits or
Disability benefits Disability benefits prior to age 65. prior to age 65.
$1000
Return to Board
Question: What is What is
Automatic Enrollment? Automatic Enrollment?
$1000
Return to Board See Question
TheseThese are the four are the four main areas covered by main areas covered by Medicare parts A, B, C, Medicare parts A, B, C,
and D.and D.
$200
Question:
Return to Board
What are What are A.A.Hospital Insurance,Hospital Insurance,B.B.Medical Insurance,Medical Insurance,C.C.Medicare Advantage, andMedicare Advantage, andD.D.Prescription Drugs?Prescription Drugs?
$200
TheseThese are Medicare plans are Medicare plans run by private insurance run by private insurance
companies that may cover companies that may cover services such as vision or services such as vision or
dental.dental.
Return to Board See Question
$400
What are What are Medicare Advantage Plans Medicare Advantage Plans
(Part C)? (Part C)?
Return to Board
Question: $400
Return to Board See Question
Beneficiaries who do not Beneficiaries who do not enroll in Medicare Part B enroll in Medicare Part B when they first become when they first become
eligible may have to eligible may have to pay pay thisthis..
$600
What is a 10-percent What is a 10-percent penalty for each year penalty for each year
that enrollment is that enrollment is delayed? delayed?
Question:$600
Return to Board
Return to Board See Question
ThisThis is the percentage of is the percentage of the bill paid by Medicare the bill paid by Medicare
when a doctor accepts when a doctor accepts assignment.assignment.
$800
Return to Board
What is 80 percent?What is 80 percent?
Question:$800
Return to Board See Question
Many individuals who receive Many individuals who receive Medicare Part A do not have to Medicare Part A do not have to pay pay thisthis for hospital services, for hospital services,
but they do have to pay but they do have to pay thisthis for for each benefit period in which each benefit period in which
they receive hospital services. they receive hospital services.
$1000
Return to Board
What areWhat are a premium a premium
and a deductible?and a deductible?
Question: $1000
Return to Board See Question
Consumers with billing Consumers with billing questions or problems should questions or problems should review one or both of review one or both of thesethese
documents and compare these documents and compare these with their personal health care with their personal health care
journals or calendars.journals or calendars.
$200
Question:
Return to Board
What are the Medicare What are the Medicare Summary Notice (MSN) Summary Notice (MSN) and/or Explanation of and/or Explanation of
Benefits (EOB)? Benefits (EOB)?
$200
Return to Board See Question
ThisThis number is number is part of a beneficiary’s part of a beneficiary’s
Medicare number.Medicare number.
$400
Return to Board
Question:
What is a Social What is a Social Security Number? Security Number?
$400
Return to Board See Question
Billing for services or Billing for services or equipment not provided equipment not provided
is potentially is potentially either of either of these.these.
$600
Return to Board
Question:
What is fraud What is fraud or error? or error?
$600
Return to Board See Question
IntentionallyIntentionally billing twice billing twice for the same service or for the same service or
item is item is thisthis. .
$800
Return to Board
Question:
What is fraud? What is fraud?
$800
Return to Board See Question
Home health services Home health services are often a target of fraud are often a target of fraud
because consumers receiving because consumers receiving these services do not have these services do not have
to pay either to pay either thisthis or or thisthis..
$1000
Return to Board
Question:What are co-pays or What are co-pays or
deductibles?deductibles?
$1000
Return to Board See Question
The acronym MSN The acronym MSN stands for stands for thisthis..
$200
Question:
Return to Board
What is Medicare What is Medicare Summary Notice Summary Notice
(MSN)?(MSN)?
$200
Return to Board See Question
$400
ThisThis is as important and is as important and valuable to thieves as a valuable to thieves as a
credit card. credit card.
Return to Board
Question: What is a beneficiary’s What is a beneficiary’s
Medicare number? Medicare number?
$400
Return to Board See Question
This state and federally This state and federally funded program helps pay funded program helps pay
medical costs for some medical costs for some individuals with limited individuals with limited income and resources. income and resources.
$600
Return to Board
Question: What is What is
Medicaid? Medicaid?
$600
Return to Board See Question
$800
Billing social activities Billing social activities as psychotherapy is as psychotherapy is an example of an example of thisthis..
Question:
What is fraud?What is fraud?
$800
Return to Board
Return to Board See Question
TheseThese CMS plans are CMS plans are not required to provide not required to provide
MSNs to clients.MSNs to clients.
$1000
Return to Board
Question:What are What are
Medicare Advantage, Medicare Advantage, Part C, or Part C, or Managed Care Managed Care Plans? Plans?
$1000