Benefit Verification Training

Transcription

1 Benefit Verification Training September 2012 Slide 1

2 Learning Objectives 1. Know why it is essential to verify benefits 2. Know which benefits need to be verified 3. Know when verification should be obtained 4. Know what information should be verified 2. Know how to verify benefits Slide 2

3 WHY Verify Benefits? Information & Referral (I&R) Level Services: Verification is NOT required to provide I&R services But, you may need to obtain verification to provide I&R Verify if it is not clear whether the beneficiary receives SSI or SSDI Slide 3

4 WHY Verify Benefits? Comprehensive Level Services: Necessary to provide individual advisement Individualized advisement tailors information to person verification essential for accurate advice Irresponsible and Unprofessional to advise without verifying Slide 4

5 WHICH Benefits Need to be Verified? Public benefits: verify all for comp level services SSI, SSDI/CDB/DWB, Medicare, LIS, MSP, Medicaid, SNAP, HUD, TANF, VA, etc. Other family members benefits when beneficiary is concerned about moving toward employment goal without knowing impact Ask probing questions and speculate! Private benefits: verify only those benefits for which individualized advisement is provided Slide 5

6 WHEN Should Benefits be Verified? During I&R: If benefit uncertain, verify BEFORE providing generic information During Comprehensive Level Services: Verify all benefits BEFORE providing individualized advisement (whether verbal or BSA) Ongoing services: If it has been at least 6 months, identify if benefits need to be reverified before providing further advisement Slide 6

7 WHAT Information Should be Verified? What must be verified varies by benefit- each benefit is different Verify pertinent details to provide individualized advisement, such as: Amount, type, entitlement date, work incentives used and available, recertification dates Recommendation for what to verify is available on Benefit Verification Quick Reference Guide Slide 7

8 HOW Do You Verify Benefits? Obtain information from administering agency 1. Beneficiary provides written documentation of current benefit(s) provided by benefit agency VA award letter, Housing redetermination notice, SNAP award/redetermination notice 2. Obtain verification from benefit agency, or partner agency with access to shared data system: Statement/Report/Letter or verbal verification Should NOT come from a third party Slide 8

9 HOW Do You Verify Benefits? Step 1 Step 1: Obtain signed releases of information Some agencies (i.e. SSA) require the beneficiary sign their specific release(s) Contact the benefit agency and clarify what releases are required Write down the protocol future reference Slide 9

10 HOW do You Verify Benefits? Step 2 Step 2: Contact agency and request verification Establish: Who you contact, how you request, what you need, and where to send it Will differ from one agency to another Establish a process (who and how) Write down protocol for future reference Benefit Verification Quick Reference Guide provides ways to verify federal benefits Slide 10

11 Social Security Administered Benefits and the Benefits Planning Query (BPQY) BPQYs verify information about SSI, SSDI/CDB/DWB, Medicare (A&B), and in some states Medicaid and state supplement: Need 2 signed releases 3288 s See BPQY Handbook for details Include fax number if want returned via fax If dual entitlement, will need to get 2 BPQYs (1 each) Contact AWIC for help in identifying who to send request to and for resolving issues in obtaining BPQYs Slide 11

12 How to Verify Other Federal Benefits Medicare Part D and Low Income Subsidy: Via state if person is Medicaid/Medicare eligible OR MSP/Medicare eligible Call Ticket Assignment: Ticket Call Center ( ) Slide 12

13 How to Verify Other Federal Benefits Veteran s Benefits ebenefits Housing and Urban Development Local Housing Authority Slide 13

14 How to Verify State Administered Benefits? Verifying state benefits differs dramatically from one state to another Build and maintain relationships with state and local benefit agencies to establish process If no effective process, contact your TA Liaison for help in creating a game plan to get an effective process Single point of contact, online verification, contacting local case worker Slide 14

15 HOW Do You Verify Benefits? Step 3 Step 3: Identify and clarify discrepancies in verification(s) Often generates more questions than answers Just obtaining the verification is not sufficient, verifications MUST be scrutinized Is it consistent with what the beneficiary told you? Is it consistent with program/eligibility rules? Is there missing or outdated information? Know who to call to clarify verification issues Slide 15

16 BPQY Discrepancies BPQY Data Sources: Master Beneficiary Record, Disability Control File, SSI Display, Summary Earnings Query, Inquiry Response Sometimes the information needs to be updated- check for issues such as: Outdated Work Activity Reviews Unreported earnings Change in living arrangement (ISM) Refer to BPQY Handbook for details Slide 16

17 RECORD CASH Type of Benefit Current Status Statutory Blindness Social Security Disability Insurance (SSDI) See Below Supplemental Security Income (SSI) See Below Disabled Child Current Pay Date of Disability Onset 12/15/09 Date of Entitlement 12/09 Full Amount $ Net Amount $ Others Paid on This Record Total Family Cash Benefit Overpayment Balance Monthly Amount Withheld BPQY CASH Example 1 Slide 17 No No Not Applicable None

18 RECORD CASH Social Security Disability Insurance (SSDI) See Below Supplemental Security Income (SSI) See Below Type of Benefit Disabled Worker Disabled Individual Current Status Current Pay Terminated Statutory Blindness BPQY CASH Example 2 No Date of Disability Onset 7/17/2011 Date of Entitlement 07/2011 Full Amount $ $0.00 Net Amount $ $0.00 Others Paid on This Record Yes No Total Family Cash Benefit $2, $0.00 Overpayment Balance $0.00 None Monthly Amount Withheld $0.00 Slide 18

19 BPQY Medical Reviews and Representation Examples Medical Reviews Next Medical Review 11/12 12/01/12 Medical Re-exam Cycle 7+ years 7+ years Representation Representative Payee Yes Yes Authorized Representative No No Medical Reviews Next Medical Review 01/12 Medical Re-exam Cycle Q+ years Representation Representative Payee No Authorized Representative No Slide 19

20 BPQY Health Insurance Examples Health Insurance Medicare Medicaid Type PART A PART B Refer to State for Start 7/2003 7/2003 determinations (1634 states) Stop Buy-In or Subsidy No No Health Insurance Medicare Medicaid Type PART A PART B Eligible for Medicaid (SSI) Start 3/2002 3/2002 (1634 states only) Stop Buy-In or Subsidy No Yes Slide 20

21 BPQY SSI Work Exclusions Example SSI WORK EXCLUSIONS Blind Work Expenses 02/11-02/11 $ /11-03/11 $ /11-04/11 $ /11-05/11 $ /11-06/11 $ /11-07/11 $ /11-08/11 $ /11-09/11 $61.89 Impairment Related Work Expenses Student Earned Income Exclusions PASS Exclusion Slide 21

22 BPQY SSDI Work Activity Examples SSDI WORK ACTIVITY Trial Work Months Start: End: Used: 0 Months Month of Cessation N/A Current SGA Level $1,010 Last Work Review Action SSDI WORK ACTIVITY Trial Work Months Start: 11/08 End: Not Ended Used: 5 Months Month of Cessation N/A Current SGA Level $1,690 Last Work Review Action 08/13/2011 Slide 22

23 BPQY Demonstration Project Information Examples DEMONSTRATION PROJECT INFORMATION Project: HOMELESS OUTREACH PROJECT & EVALUATION Start Date: 02/01/2006 End Date: not specified Slide 23

24 BPQY Recent Earnings on Record Examples IRS Recorded Earnings (Yearly) SSI Recorded Earnings (Monthly) Year Earnings Year Earnings Months Earnings Months Earnings 2001 $1, $1, /10-02/10 $1,107.37(V) 03/10-03/10 $ (V) 2003 $1, $ /10-04/10 $1,190.74(V) 05/10-05/10 $ (V) 2005 $ $ /10-06/10 $238.54(V) 07/10-07/10 $ (V) 2007 $1, $3, /10-08/10 $476.00(V) 09/10-09/10 $ (V) 2009 $5, $6, /10-10/10 $443.81(V) 11/10-11/10 $ (V) 12/10-12/10 $467.86(V) 01/11-01/11 $ (V) 01/11 01/11 $13.05(V) 02/11-02/11 $ (V) 03/11-03/11 $978.04(V) 04/11-04/11 $ (V) 05/11-05/11 $198.98(V) 06/11-06/11 $ (V) 08/11-08/11 $260.17(V) 09/11-09/11 $ (V) 10/11-10/11 $470.38(V) 11/11-Cont. $740(E) Slide 24

25 BPQY Posted SSDI Monthly Earnings Example Posted SSDI Monthly Earnings (Last Five Years) DATE Gross Wages Verified Self Employment Verified Total Countable Earnings 4/1/2011 $1, Y $ /1/2011 $ Y $ /1/2011 $1, Y $ /1/2011 $ Y $ /1/2011 $ Y $ /1/2011 $1, Y $1, /1/2011 $1, Y $1, /1/2011 $ Y $ Slide 25

26 HOW Do You Verify Benefits? Step 3-Summary All verification should get scrutinized, discrepancies identified, and clarification obtained from benefit agency Identify the appropriate process to follow with each agency to get clarification on any verification issues Slide 26

27 Document Your Verifications Maintain documentation of verification and releases, such as: Copy of BPQY or benefit award letter from beneficiary Record verbal verifications in case notes or on verbal verification record (note who, when, and what) Maintain documentation of clarification on verification Put details in case notes or on hard copy of verification (be sure to note who, when and what) Ask yourself, will my co-worker be able to pick up this documentation and understand it Slide 27

28 Additional Verification Details Include the beneficiary in the verification process If issues are identified during verification, communicate with beneficiary to identify resolution they prefer Slide 28

29 Final Thoughts Verification is the cornerstone of comprehensive services-necessary to provide accurate information Building and maintaining relationships with local benefit agencies is key to establishing an effective and efficient process for verifying benefits Create your own Benefit Verification Quick Reference Guide! Slide 29