Counseling Case Studies: Issue spotting and Problem solving

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Presentation transcript:

Counseling Case Studies: Issue spotting and Problem solving July 11, 2017

Workshop Goals Identify counseling issues in case studies Resolve problems case studies present Practice counseling skills Review relevant guidance and resources

Instructions Break into five (5) small groups Appoint one “client,” who takes 2 to 3 minutes to read through the case study Group interviews the client; spots issues; identifies problems; discusses potential solutions (15 minutes) Appoint a person who summarizes the case and reports out to large group

Resources: Case Study 1 CMS Guidance on Qualified Medicare Beneficiaries (QMB) Beneficiary Education Program: Managed Care Manual, Chapter 4, Section 200.6 Improper Billing in MA Plans: 2017 Call Letter Prohibition on Billing Medicare-Medicaid Enrollees for Medicare Cost-Sharing https://www.cms.gov/medicare/health- plans/medicareadvtgspecratestats/downloads/announcement2017.pdf CMS Medicare Learning Network Booklet Dual Eligibles at a Glance https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf

Resources: Case Study 2 CMS Guidance on the Part A Hospice Benefit Hospice Benefit: Medicare Benefit Policy Manual, Chapter 9, Section 40 - Benefit Coverage Hospice Supplies: Medicare Benefit Policy Manual, Chapter 9, Section 40.1.6 Center for Medicare Advocacy Emily Back Hospice Appeal Case http://www.medicareadvocacy.org/medicare-ruling-may-open-way-for-new-appeal-process-for- hospice-patients/

Resources: Case Study 3 CMS Guidance on Part B Durable Medical Equipment (DME) Claims Coverage Rules: Medicare Benefit Policy Manual, Chapter 15, Section 110, Durable Medical Equipment Limiting Charge Rules: Medicare Claims Processing Manual, Chapter 1, Section 30.3.12.3 Medicare Interactive Article Keeping your costs down (for DME) https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical- equipment-part-b/keeping-your-costs-down-if-you-are-not-affected-by-the-competitive-bidding- demonstration

Resources: Case Study 4 CMS Guidance on off-label drugs Part D Drug Definition: Medicare Prescription Drug Benefit Manual, Chapter 6, Section 10.1 Medically Accepted Indication: Medicare Prescription Drug Benefit Manual, Chapter 6, Section 10.6 SHIP TA Center Newsletter Article Off-Label Drug Coverage in Medicare Part D https://www.shiptacenter.org/resource-published/r2/off-label-drug-coverage-in-medicare- part-d/ Medicare Interactive Q&A Why is my drug plan refusing to cover a drug on its formulary? https://www.medicareinteractive.org/get-answers/medicare-prescription-drug- coverage-part-d/part-d-coverage-overview/why-is-my-medicare-drug-plan-refusing-to-cover-a-drug- that-is-on-its-list-of-covered-drugs-formulary

Resources: Case Study 5 CMS Guidance on Employer/Union Sponsored Group Health Plans Medicare Managed Care Manual, Chapter 9 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c09.pdf CMS Guidance on Special Enrollment Periods (SEP) Medicare Managed Care Manual, Chapter 2, Section 30.4 Medicare Interactive Article Changing Your Medicare Advantage Plan https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical- equipment-part-b/keeping-your-costs-down-if-you-are-not-affected-by-the-competitive- bidding-demonstration

Resources CMS Medicare Manuals CMS Medicare Learning Network (MLN) Internet Only Manual (IOM) pages on CMS website https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical- equipment-part-b/keeping-your-costs-down-if-you-are-not-affected-by-the-competitive-bidding- demonstration CMS Medicare Learning Network (MLN) MLN Connects Newsletter, MLN Matters https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical- equipment-part-b/keeping-your-costs-down-if-you-are-not-affected-by-the-competitive-bidding- demonstration

Contact Us SHIP TA Center Medicare Questions? medicarehelp@shiptacenter.org SHIP Center General Information Website: www.shiptacenter.org Email: info@shiptacenter.org Phone: 877-839-2679

Questions? The production of this presentation was supported by Grant No. 90ST1001 from the Administration for Community Living (ACL). Its contents are solely the responsibility of the SHIP TA Center and do not necessarily represent the official views of ACL.