Tag Archives: Insurance

Tips to Avoid CMS Noncompliance for Call Centers Selling Medicare Advantage Plans (MAPD)

This is a guest post by Scott Klonowski.

From the point of first contact all the way through the enrollment process, it’s critical to stay compliant with guidelines from the Centers for Medicare and Medicaid Services (CMS) and avoid noncompliance.

Noncompliance costs everyone money. Here are a few important ways to prevent and correct noncompliance: 

Make Sure You Have Permission to Contact & Monitor Calls

According to CMS guidelines, agents cannot make unsolicited phone calls. Additionally, many parts of the U.S. require consent for calls to be recorded. It’s important to be up to speed on state and federal regulations and ensure your agents are using the right language to obtain consent—in both incoming and outgoing calls. 

Follow CMS Marketing & Language Guidance

CMS has clear guidance on their website about presenting information to potential enrollees. Avoid any potential to mislead contacts and refrain from using absolutes or superlatives to describe Medicare plans and benefits. CMS also advises that the term “free” should be avoided when speaking about reduced costs or $0 premiums. 

Keep Health Information Safe

The Healthcare Insurance Portability and Accountability Act (HIPAA) exists to ensure security and privacy of patient health information, including Social Security numbers, IP addresses, images of their faces, account numbers, and more. It’s important to make sure you all of your agents regularly receive proper training on HIPAA, and that your internal guidance restricts the ability to share personal health information with others.

Conduct Regular Reviews & Training

Training agents once and expecting them to remember every detail isn’t sustainable. Through regular compliance training and access to updated knowledge about policies and procedures, you can ensure that your staff is knowledgeable about policy, and also knows where to look for relevant information if they have questions.

It’s also important to monitor and audit adherence to the standards and programs in place. This helps inform your training, internal protocols, and other guidelines.

Streamline Your Processes

Often, reps get bogged down working with static scripts and navigating between screens or tools that aren’t talking to each other. But there’s a way to reduce stress, increase productivity, improve customer experience, and drive sales—all while ensuring compliance.

Cue offers a simple, integrated solution that streamlines workflows and tracks adherence to compliance requirements for insurance companies with phone-based sales and support reps. With dynamic and personalized scripts and real-time call and conversation analytics, both reps and their managers can operate with more support and peace of mind.

About the Author

Scott Klonowski began his journey in insurance as a captive agent in 1993. In 2002, he started Klonowski Agency where he focused primarily on selling and servicing group health plans to small businesses in Northeast Ohio.

After 10 years of growth, Scott recognized that a Human Resources Administrative platform that companies could use to manage their benefits, payroll, timekeeping, and paid time off all in one place was missing from the market. With just a concept and no prior experience in building software, Scott started My1HR in November 2011 with his friend and business partner Glenn Leppo. In 2013, they built connectivity to HealthCare.gov for individual quoting and enrollment, and soon after built a quoting enrollment platform for independent agents, INSXCloud. After helping thousands of independent brokers and agents, Scott sold The Klonowski Agency in 2015 and My1HR in 2018.

Scott now uses his experience working with companies of every size to help business owners find success. From new companies gearing up for rapid growth to mature ones looking to sell (and every stage in between), Scott mentors and provides professional support and guidance to business owners to help them set and achieve their goals.

Simplifying Re-Enrollment Through Your Insurance Contact Centers

Every industry is feeling the impact of 2020 differently. For insurers, one new challenge is remotely onboarding new contact center agents—especially during open enrollment. This is a challenge every year, and during a global pandemic all of the challenges are magnified: training new agents to learn your systems, manage the conversation, make sure they capture customer information correctly, ensure compliance, and hit their call metrics. Whether your agents are remote or in the office, their needs are different this year and your work requires a different approach – a guided conversation tool that plugs into your CRM.

Let’s face it. The CRM tools you are using don’t do enough to address the reality we’re facing. When it comes to ensuring compliance, onboarding new reps, and routing calls quickly and precisely, no one could have anticipated a global pandemic. And as you train your reps, there are so many clicks and “shortcuts” to learn—it makes ramp-up overwhelming. In a normal year, many firms suffer high turnover, training costs, and lengthy onboarding time. And if you’re not prepared this year, the business of open enrollment could be a minefield.

As new hires work to produce results and meet targets, they must trust their training and stick to the script—questions must be answered the correct way and proper steps in the process must be followed. Agents and leadership must constantly consider the highly regulated nature of their industry, while developing strategies to guide agents through the call simply. With Cue®,  your agents can have customized conversation guidance at their fingertips, from scripts and prompts to common objections and FAQs—ensuring compliance, reducing call times, and routing calls faster. In fact, the average Cue user sees a 50% reduction in training times. Get your reps trained and on the floor faster, save money, and reduce headaches for everyone.

Good conversations are the lifeblood of your business and ours. Ensure your agents can better assist customers, streamline training, reduce talk time, and eliminate after-call work—all with the confidence that they possess the right tools to engage every person they speak to. 

If you’re interested in learning more about Cue, please submit your information and a Cue representative will reach out to you within 1 business day.