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Why Does CMS Monitor Medicare Supplement Sales Interactions During AEP?

Posted by TrendSource on 10/27/22 5:15 PM

Every year during the Annual Election Period (AEP), the Center for Medicare/Medicaid Services (CMS) closely monitors the interactions between Medicare Supplement providers and Medicare-eligible consumers.

Though ensuring compliance with these regulations can be at times cumbersome for Supplement Providers, they are worth the work. Because, while our elders are typically the wisest among us, full of experiences we should all hope to learn from, they are also relatively more vulnerable to fraud and malfeasance. This is why they are often the targets of internet scams, and children and grandchildren work together to protect them.

Sadly, the same risks for fraud and abuse surround insurance, including Medicare Supplements, with complex and jargon-filled contracts and terms that can prove confusing for anybody. Elders are nobody’s fool, but they can be fooled by unscrupulous salespeople looking to make a quick buck by signing people up for plans they neither understand nor need.

Yet, even absent this level of malfeasance, seniors can nonetheless find themselves misinformed or underinformed about their supplement plan options.

CMS AEP Compliance Audits meeting

This is why CMS has a set of regulations that all Medicare Supplement providers must follow, guiding how plans are described, what materials are available, and how questions are answered.

To ensure these regulations are followed, CMS uses mystery shoppers to closely monitor the interactions between Medicare-eligible consumers and the frontline salespeople during the Annual Election Period (AEP).

TrendSource CMS Compliance Audits

No Medicare Supplement provider wants their sales agents to violate CMS regulations because, A) It’s simply not worth the risk of punishment that violators face, and B) It’s just flat out wrong to intentionally confuse or trick people, especially our elders.

Yet salespeople can nonetheless make mistakes—it happens, they’re only human after all. Perhaps they aren’t properly trained or oriented, perhaps they’re having a bad day, perhaps they’re simply in over their head. Regardless, Supplement Providers must guard against any CMS violations.

AEP CMS Compliance Audits meeting

This starts with a robust CMS Compliance program, with Call Center Compliance Audits and Event/Appointment Audits.

With mystery shops that mimic actual CMS audits, TrendSource helps Supplement Providers and their sales force prepare for CMS monitoring, turning violations into training moments, not punishable offenses. TrendSource CMS Compliance Audits further help demonstrate a company’s best efforts to remain compliant with CMS guidelines.

Whether it’s phone calls, formal and informal events, or appointments, TrendSource offers robust and rapid CMS Compliance Audits.

We should all be thankful we live in a world in which elders are at least somewhat protected from the fraud and exploitation they face. CMS is important because it keeps everything above board. TrendSource CMS Compliance Audits help Supplement providers meet this standard and manage their risk while doing it.

Learn More About CMS Compliance Audits

Topics: CMS, CMS Compliance, AEP, Compliance for Health Care

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