SMP SMP JEOPARDY!JEOPARDY! The Administration on Aging Community’s The Administration on Aging Community’s

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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.

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Question:

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What are What are senior citizens?senior citizens?

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The acronym AoA The acronym AoA stands for stands for thisthis agency, agency, which funds the SMP which funds the SMP

program. program.

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Question:

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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)

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TheseThese are the are the twotwo agencies to which agencies to which

SMPs report their SMPs report their performance data.performance data.

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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)?

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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.

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Question:

What is SMART FACTS?What is SMART FACTS?

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TheseThese are are threethree of the of the five AoA SMP strategic five AoA SMP strategic

program objectives.program objectives.

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$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?

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Medicare, a federally Medicare, a federally funded program, was funded program, was

created by Congress created by Congress in in thisthis year. year.

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Question:

What is 1965?What is 1965?

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Individuals who are eligible Individuals who are eligible for both Medicare and for both Medicare and

Medicaid are called Medicaid are called thisthis..

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Question:

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What are dual-eligibles? What are dual-eligibles?

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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.

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Question:

What isWhat iswww.MyMedicare.gov?www.MyMedicare.gov?

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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.

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Question:What is the Centers for What is the Centers for

Medicare & Medicaid Medicare & Medicaid Services (CMS)? Services (CMS)?

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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.

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Question: What is What is

Automatic Enrollment? Automatic Enrollment?

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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.

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Question:

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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?

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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.

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What are What are Medicare Advantage Plans Medicare Advantage Plans

(Part C)? (Part C)?

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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..

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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?

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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.

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What is 80 percent?What is 80 percent?

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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.

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What areWhat are a premium a premium

and a deductible?and a deductible?

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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.

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Question:

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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)?

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ThisThis number is number is part of a beneficiary’s part of a beneficiary’s

Medicare number.Medicare number.

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Question:

What is a Social What is a Social Security Number? Security Number?

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Billing for services or Billing for services or equipment not provided equipment not provided

is potentially is potentially either of either of these.these.

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Question:

What is fraud What is fraud or error? or error?

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IntentionallyIntentionally billing twice billing twice for the same service or for the same service or

item is item is thisthis. .

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Question:

What is fraud? What is fraud?

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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..

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Question:What are co-pays or What are co-pays or

deductibles?deductibles?

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The acronym MSN The acronym MSN stands for stands for thisthis..

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Question:

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What is Medicare What is Medicare Summary Notice Summary Notice

(MSN)?(MSN)?

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ThisThis is as important and is as important and valuable to thieves as a valuable to thieves as a

credit card. credit card.

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Question: What is a beneficiary’s What is a beneficiary’s

Medicare number? Medicare number?

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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.

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Question: What is What is

Medicaid? Medicaid?

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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?

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TheseThese CMS plans are CMS plans are not required to provide not required to provide

MSNs to clients.MSNs to clients.

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Question:What are What are

Medicare Advantage, Medicare Advantage, Part C, or Part C, or Managed Care Managed Care Plans? Plans?

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