Are you the manager of a call center that services Medicare Advantage Plans (Part C) and Medicare Prescription Drug Benefit Plans (Part D)?
If the answer is yes, then you already know that the Centers for Medicare and Medicaid Services (CMS) call center monitoring period is fast approaching. And you are already acutely aware of how stressful it can be to manage, prepare, and educate your busy agents on the requirements.
This is because the pressure for the coveted 5-star rating is real. CMS conducts two studies: the Timeliness Study and the Accuracy and Accessibility Study, the results of which have high-stakes implications. Star ratings impact federal funding (i.e., bonus payments and rebates) and the ability to enroll beneficiaries and market services — all of which affect a health plan’s bottom line.
The good news is you can reduce your stress and make sure your agents are ready for CMS call center monitoring by doing some legwork in advance. So whether you’re trying to maintain or improve your star rating, here are three things you can do to prepare.
1. Partner with an LSP experienced with CMS call monitoring requirements
The reality is that not all language service providers (LSPs) are created equal. While pricing is often a powerful driver of selecting an LSP, you don’t want to cut corners when it comes to who you trust to support your CMS test calls.
Even if you already have an LSP in place, reach out to them to learn more about their approach to supporting their clients before, during, and after CMS test call season. And if you’re shopping for a new LSP, vetting them for their CMS qualifications is just as important as their breadth of languages, rates, and interpreter quality.
Here are some qualities to look for in a CMS-ready LSP:
A proven track record matters. Don’t settle for an LSP that has little or no experience with CMS test calls. A seasoned LSP will not only be knowledgeable about CMS regulations, but will staff interpreters who are familiar with CMS terms and test calls, able to correctly interpret and completely relay Medicare program information, and comfortable with protocols to ask for repetition or clarification to ensure accuracy. And an LSP’s ability to retain interpreters long term can be instrumental in this effort as well.
Communication is the cornerstone of a good partnership. Your LSP should pass along relevant updates to you and be transparent about internal protocols around CMS test calls. They should also provide you with the contact information for their key personnel and maintain open channels of communication at all times.
LSPs that handle a lot of test calls know that preparation is key. Review the CMS-specific materials they provide to their interpreters, staff, and clients to ensure the information is sound. Check to see if they attend CMS webinars, stay apprised of CMS communications, cultivate contacts within CMS, and conduct their own internal CMS test calls.
Good communication and responsiveness go hand in hand. If your LSP does not respond to your questions or quickly get back to you with details about any concerns you have, you might want to reconsider your relationship. You don’t want to be left hanging in critical moments when call center monitoring is in full swing.
An LSP that views your partnership as a true collaboration is who you want in your corner when it comes to CMS call center monitoring. They go the extra mile to do things like help streamline your CMS accounts and review call flows ahead of testing season, offer customized solutions to best support your call center environment, and assist with your internal QA call monitoring efforts for calls that require an interpreter.
2. Fortify your call center
While partnering with a seasoned LSP is critical, it’s only one piece of the puzzle. A call center is a complex system that, when running smoothly, functions as a well-oiled machine. There’s plenty you can do to ensure your call center is ready to expertly navigate CMS test calls.
- If you haven’t already, task a dedicated employee with staying current on CMS’s policies and Health Plan Management System (HPMS) memos. This can go a long way towards making sure everyone in your call center is informed and in compliance with regulations.
- Verify your current and prospective enrollee toll-free beneficiary call center numbers, toll-free pharmacy help desk numbers, and current and prospective enrollee toll-free TTY numbers. CMS pulls phone numbers from the HPMS list weekly; inaccurate phone numbers can cause organizations to receive poor results on the measures. Testing these phone numbers and ensuring they are connecting quickly also helps with the Timeliness Study.
- Periodically review your call center’s internal processes, policies, and training protocols to make sure they’re up-to-date and reflect best practices. For example, do your agents document the prospective beneficiary’s preferred language on their records? This can create a more seamless interaction so the agent immediately knows when they’ll need to connect an interpreter (and in what language).
- Ask your LSP to establish a phone line dedicated to your CMS calls to improve your ability to monitor those calls.
- Throughout the testing period, ensure your call center is adequately staffed during CMS-designated “usual business hours” so your agents can promptly answer test calls without a queue building up. This will also safeguard against exceeding the average hold times mandated by CMS.
- If you haven’t already, implement an effective, comprehensive internal monitoring program. This involves conducting and auditing your own CMS test calls to verify that every call your agents handle — regardless of whether or not the beneficiary needs an interpreter — is up to par.
- Alternately or as a supplement to your own monitoring program, you can hire a third-party CMS independent validation audit (IVA) vendor. This vendor can work with you to provide targeted consultation; develop a customized, CMS-compliant program; conduct mock CMS audits; train your staff; identify and remedy any pain points before CMS intervenes; and offer ongoing CMS audit support during the Accuracy and Accessibility Study.
3. Set your agents up for success
You’ll want everyone — from your supervisors to your agents — to be on the same page with training about CMS requirements, what to expect during test calls, and how to most efficiently connect to and conduct calls with interpreters. It’s especially important that your agents are prepared because they’re on the front line of support for your beneficiaries.
Here are some tips to help.
Clarify your agents’ roles, goals, and performance expectations so they know exactly what’s expected of them and how they can effectively contribute during CMS’s Accuracy and Accessibility Study.
Set a reminder
Remind your agents of when the test calls will be happening so they don’t get caught off guard receiving calls that might feel repetitive or scripted.
Ensure your agents have ample support during calls. That support could mean everything from a clear escalation path for questions, to supervisors on hand who can dispense guidance, to training materials they can refer to as needed.
Inform your agents
Furnish them with informational scripts to facilitate communication intended to educate and answer beneficiary questions — regardless of whether an interpreter is needed.
Inform them even more
Make sure your agents have all available info they’ll need to request an interpreter (such as your LSP’s language access phone number, their customer ID, and any reporting information they might be asked to provide).
Confirm their skills
Confirm that they’re familiar with the process to conference in an interpreter and comfortable communicating with a non-English-speaking caller through an interpreter. It’s not always an intuitive interaction, so a refresher training can’t hurt!
Don’t ignore burnout
Happy agents are effective agents. Make sure your agents feel appreciated and supported while reducing their stress in the call center. For example, reward high performance and excellent customer service; offer opportunities for advancement and new skill development; cultivate a positive work environment, employee engagement, and a cooperative rapport among colleagues; and promote good time management techniques.
In order to attain 5 stars on the CMS call center monitoring studies, you’ll want to partner with an LSP that has experience working with test calls — and the quality and speed to match. At CLI, we’ve focused on CMS compliance for over a decade, and have developed a plethora of materials and protocols to ensure our clients are fully prepared for CMS test call season.
To learn more about CMS’s call monitoring methodology, how interpreter service factors in to the Accuracy and Accessibility Study’s calculations, and how CLI’s CMS Success Program helps health plans ace these calls, download our CMS workbook today.I want CLI's CMS workbook