Information is to be reported for claims related to liability insurance (including self -insurance), no-fault insurance, and workers’ compensation where the injured party is (or was) a Medicare beneficiary and medicals are claimed and/or released or the settlement, judgment, award, or other payment has the effect of releasing medicals.
Full Answer
What are the guidelines for holding a Medicare sales event?
15 rows · Oct 07, 2021 · Give away promotional items that include plan name, logo, toll-free number, and/or carrier website 2. Use contact information provided by attendees for raffles or drawings for any other purpose. Provide refreshments or light snacks (e.g., coffee, soda, fruit, crackers) 3. Give away cash or other monetary rebates.
What is an educational event for Medicare?
Jun 25, 2015 · Educational events are events designed to inform Medicare beneficiaries about MA, Prescription Drug or other Medicare programs, but do not steer, or attempt to steer potential enrollees toward a specific plan or limited number of plans. Educational events may not include any sales activities such as the distribution of marketing materials or the distribution or …
What are the different types of marketing events under Medicare regulations?
An educational event is an event designed to inform Medicare beneficiaries about Medicare Advantage, Prescription Drug or other Medicare programs and does not include marketing/selling. Conducting any type of sales activities such as distributing marketing materials or distributing/collecting applications is strictly prohibited.
Are there CMS guidelines for hosting an educational event for enrollees?
Oct 08, 2021 · Promoting Medicare Educational Events. You can advertise these events via most forms of marketing, including newspaper and radio ads, flyers, and direct mailers. However, there are a couple guidelines you must follow when marketing educational events: All educational events must be explicitly marketed as “educational” to beneficiaries.
Which activities are permitted at an Medicare educational event?
Medicare Educational event rules: advertising You are allowed to advertise educational events through most of the usual methods such as flyers, newspapers, radio, email and direct mail. When marketing them it needs to say meetings will be for “educational” purposes.Jan 7, 2021
What is a Medicare formal event?
Educational events are events designed to inform Medicare beneficiaries about MA, Prescription Drug or other Medicare programs, but do not steer, or attempt to steer potential enrollees toward a specific plan or limited number of plans.Jun 25, 2015
How are Medicare events categorized?
Establishing Your Event There are two types of sales events: formal and informal. Here's what sets them apart: Formal Sales Events: Agent presents plan-specific information to an audience invited to the occasion. Informal Sales Events: Agent offers plan info upon request only while at a table, booth, kiosk, or RV.Oct 7, 2021
Is Event Reporting still required by CMS?
As a rule of thumb, any time you want to partake in marketing activities, structure your event as a sales event. “Talking points” used during the event and presentations used by agents need to be submitted to CMS prior to use.
What types of events must an agent report to UnitedHealthcare?
What type of events must an agent report to UnitedHealthcare? Only the marketing/sales events, both formal and informal. While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address.
Do educational events need to be reported to United Healthcare?
According to CMS regulations and UnitedHealthcare policy, agents are prohibited from conducting a marketing/sales event immediately following an educational event. There must be at least one hour separating the conclusion of an educational events and the beginning of a marketing/sales event.
Which of the following elements does not need to be entered on the new event request form when reporting a new event UHC?
Which of the following elements does not need to be entered on the NEW Event Request Form when reporting a new event? The event venue manager/contact person. Which of the following statements regarding UnitedHealthcare's event cancellation reporting rules is true?
How long are you required to maintain scope of appointment SOA documentation?
10 yearsYou must retain and store all completed Scope of Appointment forms, including any SOA for no-show, canceled, rescheduled appointments, and those that didn't result in an enrollment. CMS requires that you: Ensure all SOA forms are made available upon request for a minimum of 10 years.Oct 22, 2019
When must a marketing sales event be reported?
Report all marketing/sales events (including additional events reported throughout the month) prior to advertising the event or 10 calendar days prior to the event's scheduled date, whichever is earlier.
What is a CMS Never Event?
“Never events,” like surgery on the wrong body part or mismatched blood transfusion, cause serious injury or death to beneficiaries, and result in increased costs to the Medicare program to treat the consequences of the error.May 18, 2006
What are CMS guidelines for referrals?
In a CMS compliant situation, you would 1) ask for referrals without mentioning any benefit to the enrollee and then 2) present a thank-you gift for the referrals he or she has provided. Second, the gifts you provide must be of a nominal value.Jul 28, 2017
What are CMS permission to call guidelines?
Specifically, the Medicare Permission to Contact (PTC) rule outlines when it is okay to contact a current or potential Medicare beneficiary, the specific products they are giving you permission to contact them for, how you can approach them, and when you can contact them.Mar 25, 2020
What are the two types of marketing events under Medicare?
There are two main types of Marketing/Sales events under Medicare regulations – Formal and Informal . 1- Formal marketing/sales events are typically structured in an audience/presenter style with a salesperson or plan representative formally providing specific plan sponsor information via a presentation on the products being offered.
Can educational events be advertised as sales?
Educational events ARE NOT marketing/sales events and can only be advertised as educational.
Is an educational event a sales event?
Educational events may not include any sales activities such as the distribution of marketing materials or the distribution or collection of plan applications. Educational events must be explicitly advertised as “educational,” otherwise they will be considered by CMS as sales/marketing events.
Why do we put on events for Medicare Advantage?
Events put on to educate the public about Medicare Advantage and Part D can be a great way to establish your presence in the community. Marketing events are different than educational events because they allow you to steer members to a specific plan by providing information about plan benefits, plan cost sharing and a plan’s provider network.
What are the two types of events?
There are two types of events — sales/marketing events and educational events. CMS treats each event differently, and the type of event you are having determines how you advertise the event and what you can do marketing-wise at the event. The main difference between sales and educational events is that no sales or marketing activities can take ...
What is the difference between a sales event and an educational event?
The main difference between sales and educational events is that no sales or marketing activities can take place at an educational event. An educational event is an event designed to inform Medicare beneficiaries about Medicare Advantage, Prescription Drug or other Medicare programs and does not include marketing/selling.
Can an agent require an attendee to provide contact information?
An agent cannot require an attendee to provide contact information as a requirement in order to attend a sales event. When the event is marketed as educational, ensure all guidelines for educational events are followed. When conducting a sales event, adhere to the guidelines for marketing/sales events and appointments.
What is Medicare educational event?
Medicare educational events are an excellent way to gain the trust, and referral information, of enrollees in attendance. But before you host, present at, or attend an educational event for enrollees, there are some CMS guidelines (Medicare Communication & Marketing Guidelines, Section 50.1) you will have to follow.
Does CMS require educational events?
If you are hosting or reaching out to enrollees for an educational event, CMS requires you to explicitly market the event as “educational.”. Remember that an educational event does not include any of the following sales activities: Distributing marketing materials and any material with plan-specific information (such as plan-specific premiums, ...
When will CMS update the MCMG?
Note: CMS has released updates to the 2019 MCMG in the form of a memo in August 2019. Many of the guidelines from the 2019 MCMG, including the ones we just mentioned, as well as the updates from the 2020 MCMG memo, are still relevant for 2021.
Can you market Medicare plans?
During them, you cannot market specific plans. If marketing is your goal, you must hold and follow CMS’ guidelines for a Medicare sales event. As for the when and where, educational events may be held in a public venue. Under no circumstance should you hold them in in-home or one-on-one settings.
Can Medicare send secret shoppers?
Keep in mind, carriers may send secret shoppers to your educational events. If you violate CMS’ Medicare Communications and Marketing Guidelines, you could be subject to: Medicare beneficiaries need your expertise, and you need their trust and business.
Can you hold a virtual Medicare event?
The answer will depend on health of your state and counties, the lockdown or restrictions of states and counties, and if your carriers are even allowing in-person member events at this time. In some cases, you may be able to hold a compliant virtual Medicare educational event, but again, check with your carriers first.
What is underreporting of adverse events?
Department of Health and Human Services Office of the Inspector General (OIG) noted that underreporting of adverse events by hospital staff can be attributed to misperceptions about what constitutes patient harm and to a lack of clarity regarding what types of patient safety concerns should be reported.6 Variation in reporting practices both within different departments of a hospital and across hospitals further contributes to confusion and misunderstandings. The OIG reports were limited to considerations of events that reached the patient and caused harm (“harm incidents”). AHRQ’s Common Formats expand the area of inquiry to apply to all patient safety concerns, including harm and no harm incidents, near misses, and unsafe conditions.
What are the barriers to patient safety reporting?
Despite substantial progress over the past decade in patient safety event reporting, two interrelated obstacles limit the effectiveness of current hospital practices in identifying adverse events: 1) widespread variation in reporting systems with respect to events identified for reporting as well as their clinical definitions, and 2) underreporting of a significant number of adverse events. The Institute of Medicine, in a series of reports issued between 2000 and 2004, articulated the need for comprehensive patient safety event reporting to address the alarmingly high incidence of adverse events occurring in hospitals1,2. The findings of these reports provided impetus for the passage of the Patient Safety and Quality Improvement Act of 2005 (PSQIA). The PSQIA required AHRQ to develop and promulgate common definitions and reporting formats (Common Formats) to standardize the reporting (both internal and external) of patient safety events, both clinically and electronically. AHRQ has developed Common Formats for hospitals in collaboration with an interagency Federal Patient Safety Workgroup (PSWG), the National Quality Forum (NQF), and the public. Common Formats for nursing homes are under development.
What are common formats in healthcare?
The Common Formats support ongoing, data-driven quality assessment, regardless of hospital complexity, organization or services provided. They can be used for reporting patient safety concerns in all departments of the hospital, including general medical floors, surgery, ICUs, diagnostic and treatment centers (radiology, physical therapy, etc). The Common Formats support standardized information about the nature and frequency of events and support initial causal analysis and root cause analyses by capturing information about contributing factors (e.g., communication, handoffs, missing information, and stress/fatigue). Importantly, the Common Formats provide a harm scale for identifying and focusing on serious adverse events that may be preventable. The AHRQ harm scale standardizes evaluation of level of harm across different event types.
Why is it important to report no harm incidents?
It is important to report “no harm” as well as “harm” incidents, because in either case, mechanisms for preventing the event from reaching the patient have failed and may fail again in the future.
Do hospitals have to track adverse events?
However, several recent reports completed by the Department of Health and Human Services Office of the Inspector General (OIG) indicated that hospitals fail to identify most adverse events.
Is an incident always preventable?
Incidents are not always preventable, as they do not necessarily reflect an error in care, negligence, or poor quality. Non-preventable incidents can occur despite proper assessment and treatment. A patient may have been highly susceptible to an event because of her health status, a complex diagnosis, or lack of available information.8 In some situations, harm from treatment may have been anticipated, but the risk of harm was considered more acceptable than risk of failing to treat.
Market The Event as ‘Educational’ to Enrollees
Respond to Questions, But Avoid Plan Specifics
- This is where it may become a bit difficult for a broker at an educational event. You are allowed to answer questions that enrollees ask you. Remember, your goal at this event is to educate seniors on their options rather than upsell specific plans. While your answers should avoid including plan specifics, it may be difficult to sidestep direct questions about benefits, premiums, or copays. If …
Set Up Future Marketing Or Sales Appointments
- You may do the following at the conclusion of your educational event: 1. Distribute business cards and contact information so beneficiaries can contact you at a later date. 2. Complete and collect Scope of Appointment (SOA) forms. 3. Set up marketing appointments.
Read More Medicare Marketing Guidelines from Excelsior
- Visit Excelsior’s online resource center, where we’ve broken down each broker-focused MCMG rule. The topics range from where brokers can host educational events to proper activities at sales events and appointments. To learn more about the Excelsior team and how we can help you, contact us. Note: For the most current information, see the CMS Medicare Marketing Guidelines.