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Market Research 101: What is a CMS Compliance Audit

Posted by TrendSource on 10/31/19 9:45 AM

We are back for the next round of Market Research 101, but before we wax poetically about another market research methodology, we must acknowledge: we are nearing the end of our digital market research seminar. Sadly, all good things must come to an end and Market Research 101 is getting there quickly.

So, as we give you everything you need to know about CMS Compliance Audits, perhaps now is a good time to reflect on the journey we have been on since early this summer: the lessons we’ve learned, the jokes we’ve made, the time we’ve shared. We aren’t going to cry—we’ll always have market research, so we hope you keep your eyes dry too. And no, it’s not an accident that we saved Medicare compliance audits for last. Today’s student is tomorrow’s senior.

There will be a MRX101 recap in a few weeks. See you then!

What are CMS Compliance Audits?

CMS compliance audits are a type of healthcare market research that monitor insurance reps’ compliance with federal regulations as well as their customer service standards.

In order to sell insurance plans that supplement Medicare, companies must remain compliant with federal regulations as mandated and enforced by the Centers for Medicaid and Medicare Services. These regulations relate to the information representatives can provide and the means in which they can provide it.

health care market research

In CMS compliance audits, field agents pose as seniors or relatives of seniors shopping for Medicare supplement plans, evaluating the representative’s compliance to federal regulations as well as their adherence to customer service standards.

These audits can monitor all types of regulated 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 and apps remain compliant

Why are CMS Compliance Audits Important?

CMS compliance audits notify insurance providers of potential CMS violations before fines and other costly penalties ensue. CMS compliance audits allow providers to monitor their reps’ adherence to CMS rules (and demonstrate and document that effort), while also offering an opportunity for small-scale and system-wide corrective efforts.

That was awfully textbook-ish and we can hear some of you in the back of the class mumbling…so let’s try it like this: CMS, a federal regulatory body, monitors insurance reps selling Medicare Supplements to ensure they comply with federal regulations…if they catch violations, they impose penalties…Market Research CMS compliance audits, like the ones TrendSource provides, similarly monitor these sales reps and phone agents, but instead of imposing penalties they rapidly report violations to insurance providers, nipping violation trends in the bud.

On top of keeping insurers on the federal government’s good side, the audits also keep them on potential customer’s good side by monitoring reps’ execution of customer service standards.

How TrendSource Does CMS Compliance Audits

TrendSource relies first and foremost on its decade-plus experience in the industry. We’ve set up and executed hundreds upon hundreds of CMS compliance audit programs, particularly during the Annual Election Period (AEP). Sure, year-long monitoring programs are best, but we understand the AEP crunch, and our Field Agent network allows us to guarantee 100% coverage, 100% of the time.

Indeed, once program design is complete, TrendSource leans on its nationwide network of experienced Field Agents who know what to look for and how to look for it. Agents seamlessly blend into public events, acting and behaving like seniors and their relatives comparison shopping Medicare Supplement plans, and sound like typical callers when monitoring call centers.

TrendSource’s rapid reporting websites and custom dashboards ensure companies quickly find out when particular agents fail compliance assessments and also alert them to broader trends across region and event type.
Think of it this way: if you have a festering infection in your arm, CMS is likely to cut it off. Compliance audits are your early detection and antibiotics.

CMS Compliance

Topics: Health Care, Healthcare Solutions, CMS Compliance, Health Care Compliance, Market Research 101

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