SMP Counselor Training

1. SMP Counselor Training

2. Training Goal • Provide SMP volunteers and staff with the necessary skills and resources to • Hold one-on-one counseling sessions and • Answer simple inquiries consistently across the country.

3. Objectives • Upon completion of this training, you will be able to: • Identify the various types of questions received by the SMP • Determine the appropriate response for each type of SMP question • Use effective counseling skills and SMP resources when handling SMP questions

4. About this Training • Chapter 1: Types of SMP Questions • Chapter 2: Determining the Appropriate Response • Chapter 3: SMP Counseling Skills • Chapter 4: Handling SMP Questions See Handout 1: About the SMP Counselor Training

5. What Can I Expect from SMP Counselor Training?

6. Let’s Get to Know Each Other • Round 1: • How did you get involved in the SMP? • What is your level of experience as a counselor? • Round 2: • If you are new, what questions or concerns do you have? • If experienced, share a method for providing good counseling. See Handout 2: Counseling Experience

7. What Can I Expect as an SMP Counselor? • Simple inquiries and one-on-one counseling sessions • Provide a valuable service to Medicare beneficiaries in your state • Help your SMP achieve their goals See Handout 3: State and Local Considerations Consideration 1

8. Chapter 1: Types of SMP Questions Overview SMP vs. Other Counseling Programs Simple Inquiries One-on-One Counseling Sessions Complex Issues Identifying Types of SMP Questions

9. Why Worry about Types of Questions?

10. The SMP Mission: To empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, error, and abuse through outreach, counseling, and education.

11. SMP vs. Other Counseling Programs • Sometimes SMP staff and volunteers wear other “hats” (not just their SMP “hat”) • SHIP: State Health Insurance Assistance Program • AAA: Area Agency on Aging • ADRC: Aging and Disability Resource Center • Etc.

12. How Many Hats do YOU Wear? • If you wear multiple “hats”, consider which “hat” you are wearing! This will help you know: • What to enter in SMART FACTS • What to report to other counseling programs Consideration 2

13. Three Types of Questions Complex Issue One-on-One Counseling Simple Inquiry

14. A simple inquiry is a brief contact initiated by a consumer and/or beneficiary that is resolved with minimal time, research or review. • Brief means that the question can be answered in less than 15 minutes. • A minimal amount of research or review may be needed in order for the SMP to answer the question.

15. Simple Inquiries: Key Points • They are simple! • Many are related to the SMP mission, but some are not • Do not require the review of personal identifying information, information about a medical condition, or financial account information Tip: If you wear multiple “hats”, remember to consider which “hat” you are wearing when answering questions.

16. Simple Inquiries: Examples

17. Simple Inquiries: Importance • OIG Report (Office of the Inspector General) • Simple inquiries received • Simple inquiries resolved • 1997 – 2010 • 261,878 simple inquiries received nationwide • 249,007 simple inquiries resolved nationwide Consideration 3

18. Three Types of Questions Complex Issue One-on-One Counseling Simple Inquiry

19. One-on-One Counseling Sessions: Key Points • More in-depth than simple inquiries • Additional research or review may be needed by the SMP • Related to the SMP mission • You may need to review personal identifying information/documentation

20. One-on-One Counseling Sessions: Key Points • Help identify potential fraud, error, or abuse • Take place with one individual (or a family) • Occur in a variety of settings • After a group education session • At an SMP exhibit at a health fair • At the SMP office • Typically held in person, but can be over the phone

21. One-on-One Counseling Sessions: Examples • Basic, individualized education about how to • Read an MSN • Recognize fraud, error, and abuse • Fraud, error, or abuse is suspected but review of their MSN confirms standard Medicare billing practices • After reviewing the beneficiary’s MSN with them, you identify potential error or fraud • Send to someone at your SMP who handles complex issues

22. If you spend time educating and counseling the beneficiary beyond the level of a simple inquiry, on a topic related to the SMP mission, it’s a one-on-one counseling session!

23. One-on-One Counseling Sessions: Importance • The total number of one-on-one counseling sessions is included on the OIG Report. • 1997 - 2010 • 1,112,887one-on-one counseling sessions nationwide Consideration 4

24. Three Types of Questions One-on-One Counseling Complex Issue Simple Inquiry

25. Complex Issues: Key Points • Related to the SMP mission • Time-consuming • Involve research, including collection of detailed information and documentation • Often require the SMP to act on behalf of the beneficiary • May be identified as part of a simple inquiry or one-on-one counseling session • May result in an “SMP referral” • Require extensive training!

26. Complex Issues: Key Points If a question is related to the SMP mission, and follow-up is needed by the SMP (i.e. collecting beneficiary documentation for further research and review), it’s a complex issue! Consideration 5

27. Complex Issues:Examples that Include Potential Fraud, Error, or Abuse • A report of a potential error that the provider is unwilling to acknowledge or resolve. • A report of solicitation for equipment that has not been ordered by the beneficiary’s physician. • A beneficiary reports having been called and asked for their Medicare number by someone claiming to be from Medicare or Social Security.

28. Complex Issues:Examples that Include Potential Fraud, Error, or Abuse • A report of Part C or Part D marketing violations. • A beneficiary calls to report a scam that they avoided. • A beneficiary sees a charge on their Explanation of Benefits for a service they never received. • Residents from a senior housing complex are being offered money or gifts as incentives to utilize specific providers or services.

29. Chapter 1: Types of SMP Questions Overview SMP vs. Other Counseling Programs Simple Inquiries One-on-One Counseling Sessions Complex Issues Identifying Types of SMP Questions

30. Is the question related to the SMP mission? No. Maybe. The question is too complex to be sure! Yes. Simple Inquiry* Does the answer require review of personal identifying information and/or documentation? Complex Issue? No. Yes. Is this a brief contact resolved with minimal time, research, or review? No. Yes. Can the question be resolved by providing education or information? Simple Inquiry Yes. No. * If you are wearing more than just your SMP “hat”, see State Consideration #2 and/or the SMP Counselor Training Manual, Chapter 1, Page 2 for more information. One-on-One Counseling Complex Issue

31. Identifying Types of SMP Questions • Let’s review highlights to help you determine whether each question is a: • Simple inquiry • One-on-one counseling session • Complex issue See Handout 4: Identifying Types of SMP Questions

32. Chapter 2: Determining the Appropriate Response Answer the Question Yourself Have Someone Else Answer the Question

33. Answer the question yourself, now Get an answer and call the person back Which response is appropriate ? Send the person to someone else inside the SMP Send the person to someone else outside of the SMP

34. Tracking Form It is a good idea to use the Tracking Form (Appendix E) during the session to take notes. This will help you remember the details of your conversation, both for tracking purposes and in case additional follow-up is needed.

35. Answer the Question Yourself • Answer it now • If you know the answer, answer it • If you can get the answer quickly, ask the beneficiary if they will wait while you look the answer up • Get an answer and call back • Make sure to get the beneficiary’s name, phone number, and the best time to reach them Ask for help when you don’t know the answer! Never provide an answer if you aren’t 100% confident that it’s accurate!

36. Have Someone Else Answer the Question: Key Concepts • “Sending the person” to someone else (inside or outside of the SMP) • Implies that the SMP is providing the necessary contact information to allow the beneficiary, caregiver, or other complainant to act on their own behalf • An SMP “referral” • Implies that the question is a complex issue, and the SMP is contacting the outside agency on behalf of the beneficiary, caregiver, or other complainant

37. Have Someone Else Answer the Question Send the person to someone else INSIDE your SMP • If the question is related to the SMP mission but goes beyond the scope of a simple inquiry or one-on-one counseling session • If you are not sure if the question is a complex issue

38. Have Someone Else Answer the Question • Send the person to someone OUTSIDE of your SMP • If the question is not related to the SMP mission, empower the beneficiary to contact the outside organization themselves! • Examples of services handled outside of the SMP include: • Benefits counseling • Quality of care concerns • Medicare appeals • Change of address for Medicare / Social Security

39. Information and Assistance Services: SMP Partners • What Are They? • Get into small groups • Research 2-3 partner organizations. • Write a question that a beneficiary might ask where the answer would be to refer them to that agency. Tip: If you wear multiple “hats”, remember to consider which “hat” you are wearing when answering questions. See Handout 5: SMP Partners and Appendix B

40. Check Your Understanding Answer the question yourself, now Get an answer and call the person back Which response is appropriate ? Send the person to someone else outside of the SMP Send the person to someone else inside the SMP See Handout 6: Check Your Understanding

41. Chapter 3: Counseling Skills Steps to Effective Counseling Step 1: Set the Stage Step 2: Listen Actively Step 3: Respond Appropriately Tips for Effective Counseling What to Say, What Not to Say

42. Steps to Effective Counseling Step 1: Set the Stage Step 2: Listen Actively Step 3: Respond Appropriately

43. Make a good first impression • Greet the beneficiary • Explain how you can help Step 1: Set the Stage Step 2: Listen Actively Step 3: Respond Appropriately See Handout 7: Your Script

44. Invite the beneficiary to explain their question or issue • “What can I help you with today?” • Focus on the beneficiary • Stop. Listen. You can’t hear if you do all of the talking. • Be patient. Give your undivided attention. • Take notes Step 1: Set the Stage Step 2: Listen Actively Step 3: Respond Appropriately

45. Ask clarifying questions • Don’t make assumptions • Use open-ended questions • Confirm your understanding of the situation and the beneficiary’s needs Step 1: Set the Stage Step 2: Listen Actively Step 3: Respond Appropriately Consideration 6

46. Don’t Fall Into the Trap of Poor Listening! Going through the motions Interrupting brusquely Skimming the surface Doing all the talking

47. Step 1: Set the Stage Step 2: Listen Actively Step 3: Respond Appropriately

48. Tips for Effective Counseling • Assumptions • Body Language • Desire • Feelings • Interactive Communication • Patience

49. Tips for Effective Counseling • Point of View • Practice Makes Perfect • Professionalism and Respect • Reflection • Storytelling • Understanding

50. Some Topics Are Not Appropriate Medicare benefits and plan options Answering questions not related to the SMP mission Answering questions on SMP topics on which you have not received training