The Centers for Medicare & Medicaid Services (CMS) have set specific regulations
on how insurance companies and their agents can market to potential health plan
enrollees with the goal of protecting beneficiaries from deceptive or high-pressure
marketing tactics by private insurance companies and their representatives during
enrollment activities. CMS conducts regular compliance audits to identify organizations
that are in violation of CMS Chapter 3 guidelines, which can result in hefty monetary
penalties ($10,000 - $50,000 per violation), voluntary suspension or even termination
from the program.
TrendSource designs custom Medicare/Medicaid Secret Shopper Compliance Programs
to help mitigate the extreme risks of noncompliance and evaluate overall customer
service to internal standards. Our programs help to ensure:
- Pre-enrollment marketing materials adhere to CMS regulations
- Sales agents are not practicing prohibited sales tactics
- Promotional activities and events are conducted in compliance with CMS marketing
guidelines
- Accurate information is provided to beneficiaries
- Representatives are competent and deliver exceptional customer service
In 2011, CMS fined insurance providers over $44 million in noncompliance penalties
and terminated 168 providers from the program.
With over 200,000 beneficiaries becoming eligible for Medicare each month, the margin
for error is high—especially since CMS has recently tripled its number of Secret
Shopper interactions.
TrendSource CMS Marketing Surveillance Programs focus on the following items:
- TTY/TTD and Foreign Language Interpreter Service Call Monitoring
- One-on-One Appointments
- Formal Marketing Events
- Informal Marketing/Kiosk Events
- Educational Events
- Call Center Performance Monitoring
TTY/TTD and Foreign Language Interpreter Service Call Monitoring
TTY/TTD service allows insurance providers to audit state relay services as well as call center representatives who handle calls from hearing-impaired customers using TTY/TTD machines. TrendSource Field Agents assess the overall telephone skills, etiquette, and product knowledge of the insurance representative that answers the call and provide a detailed report of the service they received for evaluation. With Foreign Language Interpreter Service Call Monitoring, insurers are able to assess the availability of foreign language translators as well as their ability to effectively interpret the conversation in the requested language. TrendSource utilizes Field Agents who are fluent in foreign languages and in English, so that the accuracy of information given can be evaluated. Current languages supported are Spanish, Cantonese, Korean, Vietnamese, Mandarin and Russian.
One-on-One Appointments
One-on-One Appointments provide plan sponsors with a more intimate setting to discuss
plan attributes with a beneficiary. Due to the nature of this kind of meeting, it
is difficult for companies to determine if their agents and brokers are following
guidelines. At TrendSource, we track every stage of the appointment process starting
from the initial call to the actual face-to-face conversation and provide a detailed
report, outlining the complete experience so you can evaluate sales competency in
addition to CMS compliance.
Formal Marketing Events
Formal Marketing Events typically involve a sales person or plan representative
who presents specific plan sponsor information to an audience of Medicare/Medicaid
beneficiaries. Although this type of event allows for marketing and sales activities,
CMS still has limitations as to the extent of these activities. TrendSource mystery
shoppers evaluate the event using a detailed questionnaire which not only determines
CMS compliance, but also assesses the overall quality of the event and performance
of representatives.
Informal Marketing/Kiosk Events
Informal Marketing Events typically involve a kiosk or table manned by a plan sponsor
sales person and are similar to Formal Marketing Events except they are less structured.
However, informal events typically involve more risk than a formal event due to
their loose structure. Just like Formal Marketing Events, TrendSource mystery shoppers
attend Informal Marketing Events to assess sales agents' ability to accurately deliver
information.
Educational Events
Educational events are designed to provide Medicare/Medicaid beneficiaries with
general information about MA or other Medicare programs without selling intention.
Events advertised to beneficiaries as “Educational Events” prohibit hosts from engaging
in any kind of sales or marketing activities such as distributing marketing materials
or collecting plan applications. To ensure compliance with CMS guidelines for educational
events, TrendSource mystery shoppers attend these events and provide a detailed
report of their experience.
Call Center Performance Monitoring
*Plan sponsors are required to operate a toll-free call center for both current and
prospective enrollees during the annual enrollment period.*
For a Call Center Program, TrendSource works with you to construct a comprehensive
call script and detailed questionnaire that evaluates call center competence in
providing information to inquiries, handling customer complaints, availability of
services for non-English speaking and impaired beneficiaries, and operational standards
such as hold time, disconnect rate, phone etiquette, information gathering techniques,
etc., in addition to compliance with CMS guidelines. Our mystery shoppers receive
in-depth training before conducting a Call Center Shop and follow a predetermined
scenario for executing shops.
