TQJLD/HIPPA
What does HIPPA protect
Health Insurance Portability and Accountability Act
Created 1996 in order to protect sensitive patient health information from being disclosed without patient’s consent or knowledge
Does LIS (extra help) cover all costs
No
Who can a patient call to enroll into part D
Ehealth or Medicare
What does AIDET mean/stand for
A: Acknowledge
I: Introduction
D: Duration
E: Explain
T: Thank/Closing
Who verifies coverage for patients
Registration
T or F:BNs may directly transfer a patients phone call to eHealth
True: As long as BN has read the call transfer script approved by TQJLD
Is LIS coverage the same across all states
No, it varies by state. Income limits vary by state
When can a Medi/Medi patient enroll into part D
Quarterly
What are the Pillars of Patient Choice
To provide objective and fact based education and not to make any recommendations or steer patients.
How long after a patient receives a transplant can they remain enrolled into Medicare if they qualified for Medicare only because of ESRD?
36 months
What does TQJLD stand for and what do they do
Team Quest Justice League of DaVita. Team Quest, DaVita’s compliance department, provides teammates with training, tools, and guidance designed to build and maintain a culture of compliance with health care laws and regulations
What does LIS/extra help do
Helps reduce drug costs
When can a Medicare only patient enroll into part D
Bonus: Does enrolling into Medicaid automatically get you extra help.
Initial Enrollment Period – a 7 month period when someone is eligible for Medicare. 3 months before Medicare effective date and 3 months after (Month of coverage does counts)
AEP- Oct 15- Dec 7 (Coverage starting Jan 1st)
SEP (ie. change residence, move in/out of institution like a SNF, if they lose other credible Rx coverage) (BN’s do not decide if they qualify for SEP)
Bonus: Yes
What does PFE stand for?
Patient Financial Evaluation. An internal patient assisstance program.
Can a patient have Medicare advantage and a supplement plan together
No. They cannot have both at the same time. They do not coordinate
How long is the ICARL verbal consent/physical signature valid
A valid ICARL is good for 12 months from the date verbally approved or physical signature obtained.
Where can you find state specific details on LIS
BN brain
U:\Dept\CIC Team IMT\BN\BN Support Resources\BN Brain State Info
If a patient is enrolled in a part D plan and enrolls into a Medicare advantage plan that has part D included, can they keep their current part D plan?
No, they must drop their part D plan or find an MA plan that does not have part D included
What aid does a PFE offer?
Full or partial waiver of financial obligations associated with dialysis and related services
If a patient had part B but let it terminate when can they re-enroll into part B? (Can also serves as enrollment for patients that deferred part B and now want part B)
GEP-Jan 1 – March 31 with changes effective July 1
Why do we need ICARLs, Permission to Discuss, and Alternative Communications Forms?
ICARL ensures fact-based and objective education, adherence to our compliance policy, and reduces legal risk
Permission to Discuss ensures we are compliant with HIPAA laws in identifying who we can speak with other than the patient- We should always go off the most recent P2D on file and not the previous ones.
Alternative Communications Form ensures we have the most up to date information for our patient communications
Who determines LIS eligibility
Department of Human Services (DHS)/Medicaid office
If a Medi/Medi patient is dropping a MA plan to go back to original Medicare and Medicaid what happens with their part D
The patient would need to enroll in a part D if they lost their part D through dropping their MA plan
Who initiates the PFE process and when.
How long does it last
The SW and when the patient expresses financial hardship.
Good for a year
AKF will assist with which policy types?
QHP, COBRA, Medicare Part B (and MA)