Updated December 16, 2020
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?
For 2021, plans that cover health services (Part C) are scored based on 32 measures that fall into five domains:
- Staying Healthy: Screenings, Tests, and Vaccines
- Managing Chronic (Long-Term) Conditions
- Member Experiences with Health Plan
- Member Complaints and Changes in the Health Plan’s Performance
- Health Plan Customer Service
For 2021, plans that cover prescription drug services (Part D) are scored based on 14 measures that fall into four domains:
- Drug Plan Customer Services
- Member Complaints and Changes in the Drug Plan’s Performance
- Member Experience with the Drug Plan
- Drug Safety and Accuracy of Drug Pricing
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 conducts 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 tester 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 2020, 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 150 pages of content. Most of it, like the name suggests, is 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 first page describes the changes between the 2020 Star Ratings and the 2021 Star Ratings, which is very handy.
- Part 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.
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.
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.
The second memo titled “First Plan Preview of 2021 Star Ratings Data” (published the first week of 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 attain 5 stars on the call center monitoring portion, you’ll need to 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.
We know how important quality and timeliness are to you and your members, and that’s why we’ve assembled our Language Access and CMS Call Monitoring guide. The guide reviews essential information on Medicare star rating methodology and calculations, as well as our internal CMS success program. It’s a must for anyone looking to maintain or increase their star rating and provide quality care to their member base.Give Me the Guide