CMS formal events require Sales Reps to channel their inner toastmaster, giving a prescheduled presentation to Medicare-eligible attendees regarding a company’s Medicare Supplement plans. During these presentations, and the question and answer sessions that follow, they must provide accurate and accessible information while remaining mindful of strict CMS guidelines.
It’s like starring in a one-person play, immediately answering audience questions afterward, and knowing that every word that comes out of your mouth is under intense scrutiny, which could lead to costly punitive action.
This is what Medicare Supplement Providers ask of their frontline Sales Reps during the Annual Election Period (AEP), when Medicare-eligible individuals are invited to explore and change their Supplemental plans.
It is, of course, during this period that the Center for Medicare and Medicaid Services (CMS) most closely scrutinizes the interactions Sales Reps have with consumers, ensuring they do not violate the strict regulations CMS established to ensure vulnerable populations and public funded services are not exploited by unscrupulous or unprofessional activities.
Typically, this scrutiny takes the shape of robust mystery shopping programs, in which CMS operatives pose as typical Medicare-eligible consumers, evaluating the Sales Rep for their adherence to CMS strictures. In the event the Sales Rep does violates these regulations, their company faces strict punishments, which can include monetary fines and even forfeiture of contract.
In order to guard against this significant risk, Medicare Supplement Providers schedule their own mystery shops, mimicking CMS monitoring patterns. This helps their sales force prepare for actual CMS audits, while also allowing the company to make small scale internal corrective actions such as trainings to account for potential violations.
Of course, it would be prohibitively costly and inefficient for a company to engage and run their own CMS Compliance Audits, which is why even the biggest Medicare Supplement Providers in the country engage third party mystery shopping services.
TrendSource has long been a premiere provider of CMS Compliance Audits, including CMS Formal Event Compliance Audits.
In CMS Formal Event Compliance Audits, a TrendSource Field Agent poses as a typical consumer, closely monitoring the Sales Reps presentation and asking follow-up questions during the Q&A session. They pay particular attention to potential CMS violations, which they quickly note in the report they submit directly following the formal event.
CMS Compliance Audits are a key part in Medicare Supplement Providers’ compliance efforts, preparing reps and their supervisors for actual CMS audits while also demonstrating a good faith, due diligence effort to ensure CMS compliance.