Medicare Supplement Provider Ensures Year-Round CMS Compliance with Mystery Call Program

Posted by TrendSource on August 31, 2018

Background & Client Objectives

A national insurance company selling Medicare Supplements was concerned about remaining compliant with Centers for Medicare and Medicaid Services (CMS) guidelines and regulations year-round. Having already established a robust Annual Election Period (AEP) compliance program, they were looking to expand their compliance mystery shops, particularly in their call centers.

Program Development & Methodology

TrendSource suggested a regular call center mystery shop program that would help ensure year-round compliance in their English-language and translator programs. With its proprietary Field Agent database, TrendSource knew it could provide Medicare mystery shoppers in all required languages and worked with the client to determine frequency. With its decade-long experience in constructing CMS-compliant programs, TrendSource also worked with the client to develop an efficient and in-depth questionnaire that addressed client concerns and also common call center errors.

Results & Analysis

The mystery shopping program revealed several anticipated violations as well as some unexpected issues. Namely, the time it took Field Agent callers to reach a live agent occasionally extended past the allotted period. Additionally, live agents incorrectly answered certain Hard Skills questions or did not provide answers at all, which required attention. Finally, some mystery callers were unable to reach an agent due to high call volumes and no available agents, alerting the client of the need to optimize scheduling.

TrendSource quickly reported these violations within 72 hours of their occurrence, allowing the client to implement small scale corrective actions as well as streamline training programs.

Conclusion

A robust AEP compliance program is a cornerstone of any Medicare Supplement provider’s relationship to CMS. But only instituting mystery call center shops exclusively during this period allows for emerging issues to become trends and ultimately require larger scale corrective action.

In this case, the client determined it was more proactive and efficient to institute a year-round call center monitoring program and thus addressed issues while they were still nascent and not yet widespread.

Topics: CMS, CMS Compliance, Mystery Shopping, Health Care Compliance

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