Beneficiaries must complete a Scope of Appointment form before all one-on-one appointments/meetings (whether in person or over the phone) to discuss MA, MA-PD and/or PDP products. If the client wishes to discuss a product not included on the original SOA form, you must complete a new SOA to include the new product line.
Full Answer
Do Medicare Advantage plans offer home visits?
If you or someone you know is offered a home visit from a Medicare Advantage plan, keep the following in mind: If you have a serious health condition, the extra care might help you avoid a hospital stay.
How do I qualify for Medicare Advantage plans?
To qualify for Medicare Advantage, applicants must be eligible for traditional Medicare, and they must live within the service area of the plan they choose. In most cases, with the exception being seniors with very low income, enrollees pay the Medicare Part B monthly premium.
What questions should I ask when choosing between Original Medicare and advantage?
When you are choosing between Original Medicare and Medicare Advantage or between Medicare Advantage Plans, here are some questions to keep in mind. Will I be able to use my doctors?
What are the new Medicare Advantage guidelines for home care?
In October 2018, the Centers for Medicare and Medicaid Services approved new Medicare Advantage guidelines that allowed a greater degree of flexibility for enhanced quality of life, including expanded coverage for home care. The purpose of this is to allow seniors to continue living at home as long as possible.
What must all Medicare Advantage sponsors have in place in order to meet CMS guidelines?
Medicare Advantage Plans Must Follow CMS Guidelines In the United States, according to federal law, Part C providers must provide their beneficiaries with all services and supplies that Original Medicare Parts A and B cover. They must also provide any additional benefits proclaimed in their Part C policy.
When can you present a Medicare Advantage Plan?
Sign up for a Medicare Advantage Plan (with or without drug coverage) or a Medicare drug plan. During the 7‑month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
When marketing Medicare Advantage plans What must an agent do?
Tell you where to find information about the plan (website, business cards, customer service number) Discuss different plan options. Provide and collect enrollment forms if you have the right to enroll.
What is a Medicare demonstration plan?
The Financial Alignment Demonstration seeks to better serve people who are enrolled in both Medicare and Medicaid by testing a person-centered, integrated care model that provides a more easily navigable and seamless path to all Medicare and Medicaid services.
How do I switch from original Medicare to Medicare Advantage?
Simply call the number on the back of your insurance member ID card. When deciding to change to a Medicare Advantage plan, keep the following in mind: You may choose a different Medicare Advantage plan or return to Original Medicare during the Medicare Advantage Open Enrollment Period, January 1 – March 31.
What are the negatives of a Medicare Advantage plan?
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
Is a scope of appointment required for a telephonic presentation?
Who needs a Scope of Appointment? A Scope of Appointment is required for any individual in-person or telephonic marketing appointment with an agent.
What are some of the unique rules for marketing and selling Medicare plans?
Medicare has rules for how plans can contact you in different situations: By mail, radio, and print advertisements: Plans are allowed to market themselves by any of these means. They cannot, in these advertisements or in any other marketing situation, suggest that they are endorsed or preferred by Medicare.
How do I ensure Medicare compliance?
Seven steps to complianceDevelop standards of conduct. ... Establish a method of oversight. ... Conduct staff training. ... Create lines of communication. ... Perform auditing and monitoring functions. ... Enforce standards and apply discipline. ... Respond appropriately to detected offenses.
What are demonstration projects?
A demonstration project is a means of promoting innovations and capturing and disseminating best practice through the development and analysis of a live project. This can help build an evidence base to test and support industry improvements.
What is the difference between MMP and SNP?
An MMP is an alignment initiative in which Medicare and Medicaid benefits are offered as a single plan in a three-way contract between CMS, the state Medicaid agency (SMA), and the health plan; a D-SNP model is when a health plan holds a contract with Medicare and then a separate contract with the SMA to provide ...
What does MMP mean in Medicare?
Medicare-Medicaid PlanMedicare-Medicaid Coordination Office. Information and Guidance for Plans. Medicare-Medicaid Plan (MMP) Enrollment.
What is Medicare Advantage?
Medicare Advantage, also called Medicare Part C, is the supplemental plan that covers non-skilled in-home care. Medicare Advantage plans are an alternative to traditional Medicare (Medicare Part A and Part B), both of which don’t cover non-skilled in-home health care. Not all Medicare Part C plans have the same coverage and benefits.
How to contact Medicare for a disability?
Even within a state, different areas may have different types of eligibility requirements. For questions, call Medicare at 1-800-MEDICARE (1-800-633-4227) or TTY at 1-877-486-2048.
What is respite care?
Respite Care. Some plans cover respite care, which can come in one of three forms. The first is a short-term stay in a nursing home or an assisted living facility. Many assisted living communities and hospice centers have rooms designated for short-term stay residents.
Can a caregiver take a break from surgery?
Those recovering from surgery or people whose caretakers are on vacation or unable to care for their patient may benefit from this type of respite care. In-home respite care is another option for caregivers who wish to have a break but prefer their loved one to stay at home.
Does Medicare Part C cover caregivers?
Medicare Part C plans have changed to allow some of the newly covered services to be provided by a professional caregiver or family member of the recipient’s choice. However, Medicare Part C-covered caregiver services are limited to a certain number of hours per year.
What is Medicare Advantage?
In October 2018, the Centers for Medicare and Medicaid Services approved new Medicare Advantage guidelines that allowed a greater degree of flexibility for enhanced quality of life, including expanded coverage for home care. The purpose of this is to allow seniors to continue living at home as long as possible. Previously, coverage for home health care services was limited to skilled nursing care. Now, some Medicare Advantage plans cover services like housekeeping and laundry, meal delivery, ride-share for medical appointments and aides to help with the activities of daily living.
How much is durable medical equipment covered by Medicare?
Durable medical equipment is typically covered at 80% of the Medicare-approved cost. Seniors who do not need skilled care but only require personal care services are not eligible to have home health care services covered under traditional Medicare.
What is home health aide?
Home health care, which may also be referred to as home health aide services, addresses the needs of seniors who require regular health monitoring. Home health aides, also called geriatric aides, certified nursing assistants or nurse aides, are certified or licensed to provide specialized care such as checking patients’ respiration, pulse and temperature. They may also provide assistance with medical equipment like braces or ventilators, provide wound care, change catheters and administer medications. Along with skilled nursing services, home health aides may provide personal care services like help with bathing, dressing and toileting.
What is home care?
Home care services, also called personal care, attendant care, companion care or non-medical care, is limited to helping with the activities of daily living. Some care services provided by non-medical home care attendants include housekeeping, transportation for errands and medical appointments, meal planning and preparation, toileting and grooming.
Why is aging in place important?
For many seniors and families, aging in place isn’t just about enjoying the ability to embrace the security and familiarity of home, but it’s also a financially economical option. According to the U.S. Department of Housing and Urban Development, aging in place saves money, particularly for seniors who own their homes outright and are no longer paying on a mortgage. Older adults who own their homes spend less on living expenses and are able to access their home’s equity to pay for in-home mobility devices and personal care services.
What is considered home health care?
Home health care also encompasses medical supplies that are used at home, such as durable medical equipment like manual and electric wheelchairs, walkers, ventilators and nebulizers. Some injectable drugs, like osteoporosis drugs, may be included in home health care.
What is home care for seniors?
For some seniors, living at home requires a helping hand with some activities of daily living. In these cases, home care provides a balance between preserving privacy and independence and having needs met efficiently. Home care can range between highly specialized care, such as visits from a neurologist, to generalized care and companionship. It can be broken down into three categories, including home health care, non-medical home care and in-home services.
Can extra care help you avoid hospitalization?
If you have a serious health condition, the extra care might help you avoid a hospital stay. The care they provide isn’t ongoing. This is the only time you will see the clinician who examines you. The results of the exam and tests will be forwarded to your regular clinician for follow-up.
Do you have to pay more for home visits?
If you are healthy and the visit results in an increased risk score, you won’t have to pay more for your care. But the higher Medicare reimbursement your insurer receives may contribute to the nation’s rising health care costs. You are not obligated to have a home visit — they’re completely optional.
What are agent compliant activities?
Agents may conduct the following activities: Contact clients they personally enrolled to promote other Medicare plan types, (e.g., contact their Prescription Drug Plan (PDP) clients to market a Medicare Advantage Prescription Drug (MA-PD) plan and discuss plan benefits.) Contact their clients to market educational events.
Do HMOs require a PCP?
Some plans (usually HMOs) require the client to have a designated Primary Care Physician (PCP) and it will be not ed on their member ID card. If the enrollment application contains Name and ID fields for PCP information, then a PCP is required and the agent should work to populate the section.
Do you need to complete a new SOA form?
If the client wishes to discuss a product not included on the original SOA form, you must complete a new SOA to include the new product line. SOA forms are not required to attend a formal or informal marketing/sales event. The following requirements must be on the scope of appointment form or on the recorded call:
Can you contact prospective enrollees by email?
Initiate contact via email to prospective enrollees, as long as the email has an opt-out process on each communication. Some carriers do not allow agents to contact prospective enrollees by email, unless the agent has first obtained compliant permission to contact.
Can an agent call a client?
Agents can only call a potential client when the client has given express written permission to contact them. PTC can be obtained by a prospect returning a business reply card that discloses who will contact, what products will be discussed and by what specific method the consumer can expect contact.
Can agents call prospective clients?
Agents aren’t allowed to call prospective clients about MA-PD or Part D unless the client specifically asks to be called. CMS has relaxed its position on unsolicited direct email contact, but some carriers still do not allow email contact unless compliant PTC is first obtained.
What percentage of Medicare funding does home health get?
Currently, the average home health agency gets about 55% of its funding from fee-for-service Medicare, Medicare Payment Advisory Commission (MedPAC) statistics show.
Do home health organizations work with MA?
But as home health and home care organizations more frequently work with MA , they need to keep one thing in mind: The needs of MA beneficiaries are typically far more complex than those of their peers in traditional Medicare.
Answer
Answer: The correct answer is : Before making the presentation you must process a permit to carry out the visit. The entire list of specific products to be presented must also be documented. A very organized plan must always be prepared beforehand so that everything goes well.
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What documentation must include the date when the physician or allowed NPP saw the patient?
The documentation must include the date when the physician or allowed NPP saw the patient, and a brief narrative composed by the certifying physician who describes how the patient’s clinical condition as seen during that encounter supports the patient’s homebound status and need for skilled services .
What happens if a home health patient dies before the face-to-face encounter occurs?
If a home health patient dies shortly after admission before the face-to-face encounter occurs, if the contractor determines a good faith effort existed on the part of the HHA to facilitate/coordinate the encounter and if all other certification requirements are met, the certification is deemed to be complete.
