Is CMS Secret Shopping You?
That brokers (and other “Third Party Marketing Organizations — TPMOSs) need to record their calls with Medicare Advantage and Part D clients and prospects is overly burdensome for many. While there’s a concerted effort led by NAHU and others to bring some reasonable accommodations to the requirements, for now they’re here to stay.
The Centers for Medicare & Medicaid Services (CMS) made that clear last week with a memorandum concerning best practices during the 2023 Annual Election Period.
CMS reviewed thousands of complaints, hundreds of audio calls, and done some secret shopping. They believe agents are “unduly pressuring beneficiaries” and failing to provide “accurate or enough information” to make sure consumers are making informed decisions. They promise to continue close monitoring during open enrollment this year and will take compliance action when they deem it appropriate.
Their memorandum implies their focus is on agencies advertising heavily, especially on television. We’ve all seen those commercials. Sometimes twice in one commercial break. Frankly, those kind of operations should be closely monitored. Does this mean more traditional agencies should feel safe from auditing? No. Even if CMS is after large fish that doesn’t mean their net won’t catch smaller ones as well. They no doubt will.
The CMS is calling on Medicare Advantage Organizations and Part D sponsors to police their sales organizations. The agency even lists best practices for this in their memorandum.
If you sell Medicare Advantage or Part D coverage, the lesson here is simple. Know the rules and abide by them. If an error occurs, address it. Until further notice, record your calls with both prospects and clients. Most VOIP systems can make the recording process straightforward (although still annoying). Agency management systems like NextAgency can help you organize and manage these recordings.
Make a good faith effort to comply. That’s not a “get out of jail free” card, but it can go a long way to getting you through this year’s AEP. Hopefully by next year there will be more accommodating rules and regulations.
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