Show:
Basic Medicare
Enrollment
Processing
IEP/ Equitable Relief
GEP/Refusal/Withdrawal
100

True or False 

HI coverage can be refused. 

FALSE

HI Cannot be Refused. 

Slide 6

100

Name the Three Types of Enrollment Periods 

IEP

GEP 

SEP 

slide 56

100

What does the Basis of “D” and “A” represent when coding the HID & SMI Screens in MACADE?

Basis: “D” for Disability and “A” for Age-Retirement (SM 00850.315) slide 41 

100

What is the Initial Enrollment Period

3 Months before and 3 Months after the eligibility Month.

Slide 57

100
When is a Refusal considered timely? 

◦If filed any time before the SMI-START date

OR

If filed 2 months plus 7 days after notice of coverage.

slide 87

200

What is the Policy for SMI premium amounts? 

    HI 01001.014

slide 14 

200

Effective 12/01/1980 Medicare entitlement begins_____

1st day of the 25th non-consecutive month of entitlement to DIB (i.e. DOE + 2 years)

DOE (+) 24 Months

HID/SMI began on the 25th Month

200

Identify at least 3 HI SMI UTI’s

  • HIBC01 (CAPTION)- INFORMATION ABOUT MEDICARE
  • HIB191 (same dates)
  • HIB193 (SMI amount)
  • HIB002 (Medicare card)
  • HIB052 (if you do not want SMI)
  • HIB194 (state buy-in) - if applicable

slide 61

200

List 2 Policies for the Initial Enrollment Period 

HI 00805.015  

HI 00805.165

200

Stamp verses Filing date? Which date would you use to as the filing date for SMI Refusal?

The date the request is signed (filed) / date the NH visited the field office.

slide 89

300

True or False 

SSA is responsible for Sending "Explanation of Benefits Notices to beneficiaries."

False

Slide 26

300

When does the notice of Enrollment to HI & SMI get mailed to the claimant? 

Notice of enrollment to HI & SMI is mailed 3 months before age 65 or in the 21st month of DIB entitlement.

slide 53

300

To process a Medicare action in POS you will use the _____ screen.

HIHI Screen

300

When does equitable relief apply? If equitable relief does apply when will SMI start?


When enrollment is processed 6 or more months after the entitlement date.  (slide 66)

SMI will start COM 

300

If a beneficiary applied for SMI 02/18/2016 when would SMI begin?  

July 2016 

slide 121

400

When is a T2RD generated and how will you process your action?

A T2RD generates when POS is unsuccessful at processing a case. A macade action is necessary.

Slide 23

400
Does SSA or CMS send the Initial Enrollment package which includes the right to refusal form? 

CMS

Beneficiaries ONLY have to contact SSA if they DO NOT want SMI coverage

Slide 50

400

Name the 4 Screens needed when coding a HI and SMI action in macade

HI

SMI 

SPH

HST

400

List the IEP Period for the following Scenario. 


DOE 03/2010 

Eligibility Month of 03/2012 


         12/2011-06/2012

400

Prior to January 2023 how would you determine the Premium surcharge/Penalty period for a beneficiary? 

Begin counting the first month after the IEP stop counting March of the GEP year.

500

Name the system we use to review and verify Medicare data.

I.E SMI thrid party information

DBS-Direct Billing System. 

slide 29

500

If a beneficiary refuses SMI, when can they re-apply for SMI benefits?

During the GEP Period

500

What are the requirements for a claimant to Voluntarily Terminate SMI Enrollment?

Request must be

  • be made in writing,
  • unequivocally show the desire to end coverage,
  • be signed by the enrollee (or representative as indicated in- and
  • be filed with SSA or CMS. slide 86       

                                                                   

500

How do you calculate Premiums due for an Equitable Relief Period

Add all premiums from original SMI START through month before actual SMI START (usually COM)


slide 74

500

Determine if there is a Penalty and what the penalty percent is. 

DOE: 10/2018

Eligibility Month 10/2020 

GEP Filing 03/2023

IEP Period-07/20-01/21

20% Penalty