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SMP Foundations Training Chapter 1 – SMP Program

SMP Foundations Training Chapter 1 – SMP Program. Funded by the U.S. Administration on Aging Prepared in Cooperation with the National Consumer Protection Technical Resource Center. Welcome and Introductions. Take one minute or less to introduce yourself to the group. Please state your

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SMP Foundations Training Chapter 1 – SMP Program

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  1. SMP Foundations TrainingChapter 1 – SMP Program Funded by the U.S. Administration on Aging Prepared in Cooperation with the National Consumer Protection Technical Resource Center

  2. Welcome and Introductions Take one minute or less to introduce yourself to the group. Please state your • Name • Position(current, homemaker, retired, etc.) • Reason(s) for your interest in serving as an SMP volunteer Chapter 1

  3. Your Expectations for This Training Take a moment to look forward to the end of this SMP Foundations Training. Make a note of two things you hope to learn and take with you from this training. Feel free to share with the group your Expectations for this training. Refer to H-1 Chapter 1

  4. Chapter 1

  5. We Begin With Our Heartfelt Thanks Thank you for your interest in being an SMP volunteer! We need and appreciate our volunteers! Volunteers play a vital role in preventing, identifying, and reporting potential health care fraud and abuse. Chapter 1

  6. “I wouldn’t be alive if…not for Medicare. I owe Medicare something ...to keep it going so someone else can use it like I had to…I want other people to have the option of living 24 more years if they want.” -Dottie Lund, Wisconsin Chapter 1

  7. Goal of SMP* Foundations Training • To provide volunteers with a • foundationof knowledge in • three main content areas: • SMP Program • Medicare Basics • Medicare Fraud and Abuse *SMP: The acronym stands for Senior Medicare Patrol Chapter 1

  8. Objectives of Training Chapter 1 Chapter 2 Chapter 3 Refer to H-2 and H-3 At the end of this training, participants will be able to • Describe the background and mission of the national SMP program; • Identify the three roles of the SMPs; • Identify components and benefits of Medicare programs; • Describe eligibility and enrollment requirements of Medicare, Medicaid, and other assistance programs; • Review sample MSNs against case files for accuracy; • Describe how Medicare programs are subject to fraud, waste, and abuse; and • Identify strategies to combat fraud, waste, error, and abuse. Chapter 1

  9. Agenda—Chapter 1 Training Refer to H-2 • Welcome and Introductions • Goal and Objectives of the SMP Foundations Training • National SMP Program Overview • Evaluation and Wrap-Up Chapter 1

  10. Background Chapter 1

  11. Background: TheProblem The Medicare program loses billions of dollars each year as a result of errors, fraud, and abuse.* *Source: DHHS Office of Inspector General Chapter 1

  12. Who is Affected? Chapter 1

  13. According to the U.S. Congress… “Senior citizens are our best front line defense against these losses. Yet often they don’t have the information and expertise needed to recognize and accurately report cases of error, fraud, and abuse.” Source: U.S. Senate Report 104-368 Chapter 1

  14. National SMP Program Overview Chapter 1

  15. SMP: From Idea to National Program Through Public Law 104-208 ( est. 1997) — • U.S. Administration on Aging (AoA) established 12 demonstration projects to recruit and train retired professionals (likeyou!) to detect and report potential error, fraud, and abuse. • There now are SMP projects in all states, Washington DC, Puerto Rico, Guam, and the U.S. Virgin Islands. Chapter 1

  16. Goal of SMP Program To empower seniors to prevent health care fraud and abuse through outreach and education. • SMPs recruit and train retired professionals and other senior citizens about Medicare and Medicaid error, waste, fraud, and abuse. • Volunteers help their communities prevent, detect and report Medicare/Medicaid error, waste, fraud, and abuse. The majority of the almost 5,000 active SMP volunteers are retired! Chapter 1

  17. Three Roles of SMPs 1 2 3 Refer to Volunteer Manual, page 4 Chapter 1

  18. SMP Strategic Program Objectives Foster National and Statewide Program Coverage • Foster National Program Visibility and Consistency • Improve Efficiency of SMP Program While Increasing Results for Both Operational and Quality Measures • Target Training and Education to Isolated and Hard-to-Reach Populations, e.g., Low-Income, Underserved, Isolated, etc. • Improve Beneficiary Education and Inquiry Resolution Refer to Volunteer Manual, pages 4-5 Chapter 1

  19. Program Accountability • SMPs submit data semi-annually on program activities and performance results to the OIG and to AoA. • SMPs use online database— SMART FACTS*—to capture and report data. • *The Seniors Medicare Assistance and Reporting Tool for Fraud and Complaints Tracking System Chapter 1

  20. SMART FACTS Captures and Reports on • Information related to receipt, resolution, and/or referral of complex issues and complaints of health care fraud, errors, or abuse • Outreach and education activities • Volunteer time and effort Chapter 1

  21. You will Interact with SMART FACTS… • …In at least one of the following ways: • Submit timesheet and activity report forms; • Enter data of activity and reporting forms; • Access SMART FACTS Complex Issues module to refer potential fraud or abuse to an investigative entity; • Submit information about community outreach and education activities. Chapter 1

  22. SMART FACTS Log-in Screen Chapter 1

  23. SMART FACTS Screen Following Log-in Chapter 1

  24. Results Attributed to SMPs Since the program started, through 2010 • Almost $106 million in documented savings • More than 25.3 million people reached through community education events • Over 1.1 million one-on-one counseling sessions • 261,878 inquiries and 27,008 complaintsreceived related to health care fraud and abuse These figures represent results that can be tracked; Actual savings are greater than reported figures— a result of better informed consumers who directly call Medicare or the OIG fraud hotline. Chapter 1

  25. SMP Volunteers Make a Difference! In 2010 alone: 4,964 active volunteers served SMP programs; Volunteers received 53,878 hours of training and contributed 129,662 hours working in support of the SMP program Chapter 1

  26. Volunteer Responsibilities and Duties Refer to H-4 SMP volunteers fill many different roles. Use H-4 to take a self-assessment of your skills and interests. This will help you and your SMP coordinator to match you to the volunteer tasks best suited to your specific skills and interests. Chapter 1

  27. Self-Check • Use H-5 to take the self-check inventory to assess how much you’ve learned about Chapter 1 content. Refer to the SMP Foundations Training Manual to help you find the answers. Refer to H-5 Chapter 1

  28. Chapter 1 Wrap-up Chapter 1

  29. Medicare is more than a health care program. It is a promise from one generation of Americans to another. Keeping the promise is everyone’sresponsibility. Chapter 1

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