Medicare Compliance Programs Deliver Highest Ever Audit Completion Numbers for AEP 2014

This year’s Annual Election Period (AEP) provided thousands of eligible seniors (55+) the opportunity to earn extra income by participating in Medicare marketing surveillance programs conducted for insurance companies. These secret shoppers – or mystery shoppers – remain instrumental in helping Medicare insurers detect prohibited activities by their sales representatives.

With such a record number of shops completed in TrendSource’s medicare compliance monitoring program this year, there were a number of trends that came to light:

• Prospective member call centers were very busy. While posing as prospective members, TrendSource Field Agents (secret shoppers) completing call center shops experienced highly overloaded call centers. Field Agents experienced long hold times, disconnections, and in some cases were even told to call back at a later time, or they would receive a call back later.
• Languages are changing for interpreter services calls. CMS has communicated they will be using French and Tagalog for their Interpreter Services Monitoring calls in 2014 (in place of Russian and Korean languages). Starting in October, TrendSource began receiving requests to modify the languages used to conduct Interpreter Services monitoring calls.
• Bound booklets are becoming increasingly more prevalent for marketing materials. Bound kits containing all necessary enrollment kit items (Enrollment forms, Summary of Benefits, Plan Ratings Information and Multi-Language information) were used in place of these items being provided as loose materials.
• Event types were logged incorrectly. Many Field Agents experience incorrectly logged event types (ie: formal logged as “informal”). This was typically the result of events being uploaded incorrectly to HPMS.

“This year’s AEP programs were incredibly successful,” said Amber Berger, CMS Compliance Account Manager at TrendSource. “In our 5th AEP season, we’ve gotten to a place where we are able to more strategically guide and advise our clients on not only what type of surveillance activities they should be conducting, but also on what the compliance ‘hot buttons’ are. This guidance will become more and more important as the world of healthcare changes. We plan to be there to assist our clients mitigate the changing face of healthcare.”

TrendSource runs yearlong CMS Compliance Secret Shopping Programs for most clients, providing ongoing feedback to safeguard corporate integrity and remain compliant with the guidelines set forth by the Centers for Medicare & Medicaid Services (CMS). For more information about TrendSource Secret Shopper Compliance Programs, email us.