Executive Briefing

Introduction

For 2013, the Center for Medicare and Medicaid services (CMS) is continuing its call center monitoring program. This monitoring ensures that your call center is in compliance with CMS timeliness standards as they pertain to both average hold time and disconnect rates.

As you may know if your organization fails to maintain an average hold time of less than 2 minutes and a disconnect rate no higher than 5%, CMS may take compliance actions against your company.

Call Center Monitoring Background

As in the past several years, CMS, assisted by Research Triangle Institute (RTI) International, will monitor plan sponsors’ call centers to ensure compliance with CMS call center stand- ards. CMS conducts two studies, and each study is described below.

The timeliness study measures Medicare Part C and Part D current enrollee beneficiary call center phone lines and pharmacy technical help desk lines to determine average hold times anddisconnectrates. This study is conducted year round, with quarterly compliance actions taken when an organization fails to meet CMS standards.

CMS Compliance Measures and Actions

The accuracy and accessibility study measures plan sponsors’ Medicare Part C and Part D prospective enrollee beneficiary call center phone lines to determine (1) the availability of interpreters for individuals, (2) TTY/TDD functionality, and (3) the accuracy of plan information provided by customer service representatives (CSRs) in all languages. This study is conducted from February through May, and compliance actions will be taken when an organization’s interpreter availability is less than 75%, its TTY service score is lower than 60%, and/or its rate of accurately answering questions is below 75%.

Organizations deemed to be non-compliant will receive notices via email. Languages to be tested in 2013 are: Cantonese, Mandarin, Vietnamese, Spanish, Russian and Korean. In addition, English will be tested as a foreign language for organizations with a service area exclusively in Puerto Rico.

Tips for Success

Based on years of study results, CMS provides the following tips to help improve results.

Interpreter availability:

  • Utilize an interpretation service to identify the beneficiary’s language.
  • Use interpretative services personnel who are familiar with healthcare terms and Medicare benefit concepts.
  • Train CSRs to connect foreign-language callers with an interpreter.
  • Ensure CSRs stay on the phone when a foreign-language interpreter joins the call.
  • Ensure IVR systems default to a live CSR/operator if the caller does not push any buttons or make a verbal selection from an options menu.
  • Include a note on the beneficiary’s call center record that indicates his/her preferred language, if other than English. Maintain and use a tracking system so that once a beneficiary’s language is identified, it is recorded and used for future contact (both oral and written).
  • Monitor CSR calls to ensure that LEP beneficiary calls are being handled according to the sponsor’s policies and procedures.
  • Remind CSRs that CMS study is underway February through May, and inform new staff of CMS study so they are not taken off guard by foreign-language callers.

Information Accuracy:

  • Ensure that CSRs can respond to questions regarding items listed in the Medicare Marketing Guidelines, Section 80.2.
  • Review 2013 edition of Medicare & You to ensure your CSRs are trained on new Part C and Part D benefit information for 2013.
  • CSRs should have specific plan benefit package (PBP) level benefit and formulary data easily available.

Results

Results will be available quarterly through the Health Plan Management System (HPMS) at the following paths:

  1. For Part C results, from the HPMS home page (https://www.hpms.cms.gov)
  2. For Part D results, from the HPMS home page (https://www.hpms.cms.gov)
  3. For Pharmacy technical help desk results, from the HPMS home page (https://www.hpms.cms.gov)