The Centers for Medicare & Medicaid Services (CMS) will continue monitoring Part C and Part D call centers in 2017. This monitoring will ensure compliance with CMS call center standards in the areas of Timeliness and Accuracy and Accessibility. At CQ fluency, we understand the importance of call center compliance.  The following information is crucial for call centers, both to provide service to some of the most vulnerable groups in our society and maintain regulatory compliance.


Timeliness and Accuracy and Accessibility

The Timeliness study measures current enrollee beneficiary call center phone lines and pharmacy technical help desk lines to determine average hold times and disconnect rates.  Quarterly compliance actions will be taken when an organization fails to maintain an average hold time of 2 minutes or less and/or when an organization has an average disconnect rate greater than 5%. This study is conducted year-round and thresholds are adjusted for margin of error.

The Accuracy and Accessibility study measures organizations’ prospective enrollee beneficiary call center phone lines to determine the availability of interpreters, teletype (TTY) functionality, and the accuracy of plan information provided in all languages. This study is conducted from approximately February through May and compliance actions are taken when an organization’s interpreter availability is less than 75%, its TTY service score is lower than 65%, or its rate of accurately answering questions is below 75% (thresholds are adjusted for margin of error).


Compliance Success

In order to successfully meet the requirements of these studies, it is important that organizations keep the Health Plan Management System (HPMS) up to date. Current, prospective, and TTY customer service call center toll-free telephone numbers must be entered in the proper locations in HPMS. If there are updates at any time during the year, please enter them into the system immediately, as a delay in updating phone number(s) will result in unsuccessful calls for your plan(s).


Using Interpreters

To successfully meet the requirements of interpretation for customers, use an interpretation service to identify the beneficiary’s language and use interpreter services personnel who are familiar with healthcare terms and Medicare benefit concepts. Train customer service representatives to to connect foreign-language callers with an interpreter and ensure that the representative stays on the phone when a foreign-language interpreter joins the call. Interpreters should be available within 8 minutes of the caller reaching a CSR.
Ensure that interactive voice response (IVR) technology systems default to a live CSR or operator if the caller does not push any buttons or make a verbal selection from the options menus, as test callers will not make a selection if the instruction is only in the primary language.

A best practice is for CSRs to speak at a high level first and offer more detail if asked. This is due to the time limit of 7 minutes for each of the general accuracy questions. It is important to make notes on the beneficiary’s call center record that indicates his or her preferred language. Also, maintain and use a tracking system so that once a beneficiary’s language is identified, it is recorded for future use.


Ability to Accept Calls

If your organization intends to implement any new technology affecting phone systems, it is vital to ensure that it will not interfere with the organization’s ability to accept calls. All call centers must be open for calls from 8:00 a.m. to 8:00 p.m. for all of your plans’ local service areas. Check carefully to verify coverage for any counties that might be split into two time zones or may observe daylight savings time. Finally, ensure that your organization does not employ IVR logic that will block certain times based solely upon the area code of the caller.  


TTY Functionality

If your organization uses an in-house TTY device, regularly test the device to ensure that is working properly. Have a staffing plan that includes coverage for the TTY device during the hours your call center is required to operate with live customer service representatives. Messages that ask a caller to leave a phone number are not appropriate and will not be counted as a successful call.  A CSR is considered unavailable if the caller or relay operator is unable to communicate with the representative.


Need Assistance with Phone Interpretation?

CQ fluency offers professional phone interpretation services that help you acquire and retain customers, lower costs, and comply with regulations regarding Limited English Proficiency populations.  Not only do we provide interpretation services in over 200 languages, we understand the nuances that cultural and regional differences create within a language and are equipped to help provide service specific to those differences.  For more information about our phone interpretation services, please see our phone interpretation page, or click the link below to contact us for more information.