CMS Compliance: Nip Your Violations in the Bud

Avoid costly penalties and lost contracts by staying on the right side of Center for Medicare/Medicaid Services (CMS) regulations. Our Field Agents perform over-the-phone, in-person, and online audits of your company’s representatives to ensure the information they provide is accurate, helpful, and, most importantly, compliant.

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CMS Compliance: A Multi-Front Battle

These days, seniors engage insurance providers across multiple channels, but, whatever form those interactions take, they must remain compliant with CMS regulations. The elderly are better informed than ever: they love comparison shopping providers, and they are bound to contact your company’s reps in the field, online, and on the phone. That's a lot of people doing a lot of interacting in a lot of places, all on your company’s behalf. And, according to CMS, you are accountable for the information provided in those conversations.

How can your company ensure that their sales team provides accurate information on enrollment criteria and supplemental options, to say nothing of such esoteric topics as coverage gaps and extra help? How can you be confident they do not unduly pressure or coerce customers into enrollment? And how can you know that, in addition to remaining compliant, reps are providing an excellent customer experience?

CMS Compliance Audits give that certainty and confidence by alerting companies to potential violations and providing time to implement corrective action before it's too late. Whether on the phone, online, or in person, our agents will mystery shop all customer-facing interactions, including:

  • Phone calls to call centers
  • Informal informational events at pharmacies and other public spaces
  • Formal event presentations 
  • One-on-one appointments
  • Walk-ins during open office hours
  • Translator evaluations for all over-the-phone and in-person events
  • Online audits to ensure websites remain compliant

Our deep Field Agent database ensures that reps never interact with the same Mystery Shopper more than once, and guarantees 100% coverage across the country, wherever the remotest of remote events may be.

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CMS Compliance, the TrendSource Way

We have been doing this for a while, and, frankly, we've gotten quite good at it. And that's why the nation's top insurance providers already trust us to deliver timely, accurate, and actionable information on a daily basis.

We understand that, while regulations are uniform, each insurer must follow their own path to compliance. That means that we custom build our programs and questionnaires, offering:

  • Comprehensive programs to establish a baseline and then validate future efforts
  • Custom-built questionnaires to target areas already identified as problematic
  • Annual Election Period (AEP) programs to monitor employees at the most important time
  • Year-round programs to ensure continued compliance and that standards don't slip after AEP ends

Most importantly, no matter what program type your company chooses, we alert you to potential violations within 48 hours of their occurrence.

That means time to quickly implement small-scale corrective action, nipping compliance concerns in the bud before they blossom into penalized violations. Indeed, as our clients have already found: better small-scale corrective action today than full-scale crisis tomorrow. Sure, it costs to stay compliant...but violations are far costlier.

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