Why Supplement Providers Should Run CMS Compliance Audits Year Round

As we approach the Annual Election Period (AEP), supplement providers are rightly preparing their call center and in-person sales force for increased volume and heightened regulatory attention from the Center for Medicare/Medicaid Services (CMS).

Yet preparation for AEP should begin well before October 15. Indeed, with TrendSource as a compliance management partner, Medicare Supplement Providers should consider instituting year-round CMS Compliance Audits.

Why Providers Run CMS Compliance Audits During AEP

AEP accounts for the majority of call volume and in-field events since it is the only time of year that enrollees are permitted to change their providers and plans. By sheer quantity, the amount of consumer touchpoints active during AEP dwarfs the remainder of the year.

For this reason, CMS is particularly stringent in monitoring for compliance during this period. Because the majority of interactions between staff and consumers take place during this period, it falls to reason that the majority of violations also occur during this period. Thus, the heightened attention from CMS. Of course, any violations that CMS catches can result in costly fines and even forfeiture of contract.

Owing to this heightened attention, supplement providers concentrate their compliance audits within AEP, hoping to catch violations before CMS does, while also being able to point to the compliance program’s very existence as due diligence to stay within regulations.

TrendSource Year-Round CMS Compliance Audits

Yet supplement providers should consider implementing year-round CMS Compliance Audits for two key reasons:

• Monitoring interactions all year prepares staff for upcoming AEP, meaning they will have made their mistakes and learned from them before primetime. Providers can institute small scale corrective action before they are faced with punitive action.
• A year-round program signals to regulatory authorities that the provider went the extra mile to ensure their compliance. This can only be helpful in the case of a violation during AEP.

Yes, the majority of business is concentrated in AEP, but providers risk violations if they just throw their staff into the deep end the day it begins on October 15, 2022. Monitoring their staff and implementing small scale corrections helps to train them to better serve customers and to remain compliant with CMS regulations.

This is why TrendSource offers CMS Compliance Audits throughout AEP and year-round.

TrendSource CMS Compliance Audits can be any combination of the following:

• CMS Compliance Phone Call Audits
• CMS Translator Call Compliance Audits
• CMS Event Compliance Audits
• CMS Appointment Compliance Audits

It is absolutely imperative that providers implement a CMS Compliance program during AEP. But year-round audits are an even smarter move.