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tips for call center monitoring compliance

3 key tips for call center monitoring compliance

The Centers for Medicare & Medicaid Services (CMS) will continue monitoring Part C and Part D call centers through 2021/2022.

This monitoring assesses and ranks compliance with CMS call center standards in the areas of Timeliness and Accuracy and Accessibility. At CQ fluency, we understand the critical nature 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.


quick tips for ensuring compliance

timeliness, 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).

Timeliness study measures

working with expert 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.

working with expert interpreters

understanding CMS star ratings

he CMS measures successful call centers for Medicare Plans with a 1-5 star scale. Performance is evaluated in terms of plan quality and communication efficacy.

Of the 48 measures that go into calculating CMS Star Ratings, 2 are directly related to quality of services provided by CQ fluency:

C34 and D01 in the Medicare Report Card are directly related to foreign language accessibility during Call Center Monitoring
By randomly testing our call centers, we can ensure our expertise in timeliness, accuracy, and accessibility in our call center compliance

understanding CMS star ratings
CQ fluency’s framework for call center monitoring compliance

CQ fluency’s framework for call center monitoring compliance

We are experts in multilingual call center success. Want to learn more about how you can maximize your call center performance? Partner with CQ fluency today to prepare for the upcoming call center monitoring period.

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