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“"An ounce of prevention is worth a pound of cure."
Benjamin Franklin
American Statesman

CMS Marketing Surveillance

safeguarding integrity & avoiding costly sanctions for healthcare insurance providers

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.

healthcare mystery shopping services & HCAHPS surveys to improve the patient experience

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Medicare Medicaid CMS compliance audits, CMS mystery shopping, CMS Marketing Surveillance, patient experience management, healthcare mystery shopping

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4/19/2014