We’re quickly barreling toward the Centers for Medicare and Medicaid Services (CMS) call center monitoring period, which will ramp up in February with its Accuracy & Accessibility Study (the Timeliness Study is performed quarterly).
CMS developed its 5-star rating system to measure the quality of CMS’s Medicare Advantage (MA) Plans and Medicare Prescription Drug Plans (Part C and Part D, respectively) to ensure its beneficiaries have access to affordable, high-quality coverage.
Where Does Call Center Monitoring Figure In?
Both Part C and D have domains dedicated to customer service that are broken down further to include how the plan handles member appeals and foreign language interpreter and TTY availability.
To measure foreign language interpreter and TTY operator availability, CMS auditors conduct test calls. These test calls measure the percentage of time these services were available to a prospective beneficiary when needed. In addition to availability, the auditor also confirms that prospective beneficiaries are receiving an accurate and complete interpretation of plan benefits.
The scores, ranging on a scale from 1 to 5, are determined based on set criteria.
CMS Star Ratings: What’s the Big Deal?
Now that we know how call center monitoring fits into CMS’s star rating system, it’s important to recap why receiving a high score is so crucial:
- Some MA plans receive quality bonus payments and/or rebates that correspond with their star rating. For bonus payments, a higher rating means they are able to offer their beneficiaries either a lower premium or increased supplemental benefits. For rebates, a higher rating means they are able to offer their beneficiaries increased supplemental benefits.
- Star ratings are published on the Medicare Pathfinder (MP). If a plan receives a score of fewer than 3 stars for three years in a row, the plan is flagged with a low-performing icon.
- MA plans that receive a 5-star rating can enroll beneficiaries and market their products year-round.
Lots of planning, organization, and training go into preparing for CMS call monitoring. To make sure all that preparation doesn’t go to waste and you’re up to speed for 2025, we’ve put together three resources to assist you in achieving success.
1. Part C and D Performance Data
The CMS Part C and D Performance Data page hosts a ton of information. You’d be hard-pressed to analyze all of it in one sitting, but here are some highlights:
Star Ratings User Call slides
A helpful deck that quickly outlines the changes to the star rating program for the upcoming year.
Star Ratings Technical Notes
The technical notes comprise over 200 pages of content. Most of its contents are very technical, but it does go into great detail about each measure and the methodology used to score and assign stars. The bottom of the introduction describes the changes between the previous Star Ratings and the upcoming Star Ratings, which is very handy.
Part C and D Medicare Star Ratings Data
The pièce de résistance, this hefty zip file contains the raw data for all measures collected for every health plan monitored. (Note: not all plans will have a result for every measure.)
Results from previous years
The results from 2007 to the present are listed, which is helpful if you’d like to comb through the data to see how you stack up year after year.
Related: Questions to Ask Your Language Services Provider about CMS Call Center Monitoring
2. HPMS Memos
CMS’s Health Plan Management System (HPMS) releases memos throughout the year, some of which contain specific information regarding star rating data, preparation, and instruction.
While all the CMS star rating memos are worth reading, there are two that can’t be missed.
Part C and Part D Call Center Monitoring — Guidance for Timeliness and Accuracy & Accessibility Studies
First, the “Part C and Part D Call Center Monitoring — Guidance for Timeliness and Accuracy & Accessibility Studies” memo (look for it in November or December) covers the elements CMS will monitor.
It outlines important definitions, where to access results, how and why to verify your call center phone numbers, and tips for success.
Plan preview
The second memo with the subject “First Plan Preview of 2025 Medicare Parts C and D Star Ratings Data” (published historically in early August) notifies recipients of when performance metrics from the previous study will be available for review before they’re calculated into the final star rating.
This gives plans the opportunity to review their scores and note any discrepancies before they’re published on the MP.
3. CLI’s Language Access and CMS Call Monitoring Guide
In order to do well on the call center monitoring portion, partner with a language service provider that has experience working with CMS test calls — and the quality and speed to match.
At CLI, we’ve focused on CMS compliance since 2008. We’ve developed materials and protocols to make sure our clients and interpreters are prepped for CMS test call season.
And our guide reflects that knowledge.
It can help you further understand how interpreters prepare for CMS test calls, what to look for in a quality language service provider, and tips on how to make the most out of your own call center.
It’s a must for anyone looking to up their interpreting quality for call center monitoring and beyond. Check out the guide today!
