As originally posted by Call Center Times:
The Centers for Medicare & Medicaid Services (CMS) is enacting new guidelines that directly impact healthcare professionals, insurance vendors, and the healthcare industry at large.
The changes go into effect Oct. 1, 2022, just in time to start the 2023 Annual Election Period for Medicare Advantage and Medicare Part D plans. With the deadline only a few weeks away, many agents and brokers are scrambling to determine the most efficient and cost-effective way to comply with the new requirements
The good news is the technology needed to meet compliance is relatively straightforward. The challenges lie in navigating the nuances of CMS’ changes and instituting processes that are consistently followed by agents and brokers to ensure compliance.
Reason for Change
While no specific explanation was provided, most believe the ruling is in response to a massive increase in complaints to CMS about misleading TV commercials. These commercials are distributed by third-party marketing organizations (TPMOs) and often utilize celebrities to distract from questionable statements.
In many cases, complaints are aimed squarely at the TPMOs trying to convince beneficiaries to switch plans to one that does not meet their needs — or even match what was advertised. Regardless, CMS has still decided to expand its definition of TPMOs to include all healthcare agents and brokers.
What are the New CMS Requirements?
The CMS Final Rule 2023 was announced in May 2022 and requires all Medicare and Medicaid marketing calls to be recorded and stored for at least 10 years.
Call Recording Requirements
The language is important here as CMS has confirmed it interprets “enrollment” as “marketing.” The call recording requirement applies to all healthcare agents who enroll beneficiaries in new plans. Healthcare agents and brokers will be required to record all “marketing” calls with beneficiaries in their entirety, including the enrollment process. This rule applies to both new and existing clients. The call recordings must then be stored in a HIPAA-compliant manner for at least 10 years.
CMS considers a “marketing” call anything that falls under the “Chain of Enrollment,” which is defined as any events from the point when a beneficiary is made aware of an MA/PDP plan to the end of the enrollment process. Some examples of what the new recording rules cover include:
- Contacting potential clients
- Scheduling appointments for new and current clients
- Collecting drug and provider lists
- Hosting informational meetings
- Enrolling clients by phone
Here’s an example. An agent is discussing a Medicare Supplement, which is not included in the new call recording rules, but if the agent bundles that Medicare Supplement with a Prescription Drug Plan, the call will indeed need to be recorded since it now falls under the purview of a Part D discussion.
Keep in mind that the new CMS rules apply to video calls and online application walkthroughs as well. Whether an agent uses Google Meet, Zoom, or any other video conferencing service, they’ll need to know how to record those conversations.
The only real exception to the new recording requirements is in-person meetings. That said, any follow-up calls or video meetings throughout the enrollment process must be recorded and stored for a minimum of 10 years.
NOTE: This health insurance market reform will not affect State Health Insurance Assistance Programs (SHIPs).
All agents will also be required to include the following disclaimer:
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”
The disclaimer must be included in the following places:
- Verbally expressed within the first minute of a sales phone call
- Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means
- Prominently displayed on the agent’s or broker’s website
- Included in all marketing materials, including print collateral (12-point font) and television advertisements
Additionally, the following requirements must be included in all call recordings and appointment forms:
- Date of appointment
- Beneficiary and agent contact information
- Product types to be discussed
CMS has stated that there is no obligation to re-enroll current Medicare participants and their enrollment status will not be affected. Automatic enrollment will also not occur. That said, a new Scope of Appointment (SOA) is required if the beneficiary requests information about a plan not previously discussed.
NOTE: CMS has not laid out a compliance verification or auditing plan for the Final Rule 2023 changes.
How to Achieve Compliance
Ensuring agents can meet these new CMS requirements by October 1, 2022, comes down to two primary factors: technology and training.
Modern VoIP communications providers can help agents and brokers secure the technology required to address these changes, including call recording, cloud storage options, and pre-recorded messages so agents don’t slowly lose their sanity repeating the same disclaimer on every call.
Automatic Call Recording
Automatic call recording does just that — starts a new recording at the beginning of every phone call. No button presses or Start/Stop commands required. Talk normally and the audio file will automatically be saved for future review.
On-Demand Call Recording
The new CMS call recording requirements cast a wide net, but there are instances in which a call wouldn’t have to be recorded. Agents and brokers may consider recording those calls anyway, but it would result in exponentially more recordings to categorize and store. However, the danger in not recording them is that these calls could potentially take a sharp turn into “Chain of Enrollment” territory.
On-demand recording is the alternative to recording every single call. This allows agents and brokers to meet CMS requirements and maintain the natural flow of the conversation even when recording may unexpectedly be required. Perhaps even more importantly, on-demand recording allows agents to immediately turn off call recording if a client declines to be recorded.
Call Recording Storage
The aspect of CMS Final Rule 2023 with the most long-term impact is the requirement that insurance vendors store all call recordings for a minimum of 10 years.
Relying on internal servers and manual organization to maintain and store recordings in a HIPAA-compliant manner would quickly become an untenable nightmare. A HIPAA-compliant cloud storage service that is integrated with call recording software is the most seamless and stress-free path to meeting this requirement and one that is available from most communication services providers.
Many communication services providers offer training and 24/7 support to help clients navigate new functionality and issues when they encounter them. Some also provide easy-to-use dashboards enabling customers to turn features on and off as their needs change.
Agents and brokers still contemplating how to address the CMS changes should connect with their phone service provider to determine if they offer the features listed above or find a service provider who does and request an expedited onboarding process to ensure agents and brokers have the time needed to learn new workflows and memorize the new disclaimers. While change can be difficult, especially when it involves the introduction of new technologies and processes, most VoIP services are simple to use within minutes and make processes and communication smoother in the long run.
About the Author
Kerrin Parker serves as Chief Customer Officer of FluentStream, the fastest-growing unified communications-as-a-service (UCaaS) provider for small and medium-sized organizations. Parker is a champion of customer success and business transformations. She can be reached at email@example.com.