REQUIREMENT
Effective October 1, 2022 Field Agents will be required to record all sales and marketing calls in their entirety. The recordings must be retained in a HIPAA compliant manner for 10 years. View details on the new CMS rule here.
This pertains to calling leads, scheduling appointments, collecting drug and provider lists and conducting phone enrollments. ![]()
Only in person, face to face appointments are excluded, however any follow up calls related to sales and completing the enrollment process must be recorded.
Additionally, a new disclaimer must be verbally conveyed within the first minute of a sales phone call.
Now is a great time to make sure you have access to Sunfire's enrollment platform and have a solution in place for the upcoming 2023 AEP.
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Medicare Blog | Medicare News | Medicare Information
Sunfire: Integrated Telephony for Field Agents
Posted by www.psmbrokerage.com Admin on Mon, Aug 15, 2022 @ 02:16 PM
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Tags: Medicare Advantage, CMS, AEP, SunFireMatrix, Compliance, 2023
2023 CMS Final Rule – Third-Party Marketing Organization guidelines
Posted by www.psmbrokerage.com Admin on Wed, Aug 10, 2022 @ 08:38 AM
2023 CMS Final Rule – Third-Party Marketing Organization (TPMO) Guidelines Medicare Advantage organizations are responsible for ensuring that Third-Party Marketing Organizations (TPMOs) adhere to all applicable laws, regulations and CMS guidelines, including the requirements for conducting lead generation, marketing, selling, and enrollment activities with Medicare beneficiaries as outlined within the 2023 CMS Final Rule released May 9, 2022. Please review and implement the new requirements outlined below. New TPMO disclaimer The following new disclaimer needs to be on all third-party CY2023 materials, effective for marketing beginning October 1, 2022: “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 of your options.” TPMOs must add this disclaimer to any previously approved material. This disclaimer must be:
Compliance oversight of all lead sources TPMOs are responsible for compliance oversight including ensuring all lead sources used to solicit Medicare product enrollments are compliant with CMS guidelines, and all other state or federal laws, rules and regulations. This includes but is not limited to ensuring that the TPMO, when conducting lead generating activities, either directly or indirectly, for an MA organization, must:
Recording calls with beneficiaries TPMOs, including lead generation vendors and downstream related entities, must record all calls with beneficiaries in their entirety. In addition, TPMOs must retain and make the recordings available upon request for a minimum of 10 years. This includes calls that are part of the chain of enrollment into a Medicare Advantage or Part D Plan (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision), as well as post-enrollment telephonic discussions This rule applies to telephonic conversations only, not face-to-face meetings. Questions? Thank you for your cooperation in ensuring compliance with these requirements. If you have any questions, please contact us here or call 800-998-7715.
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Health agents seek reversal of CMS rule on recording Medicare Advantage calls
Posted by www.psmbrokerage.com Admin on Wed, Jul 27, 2022 @ 09:35 AM
Or the phone rings, and the person on the other end of the line says they represent a Medicare Advantage plan that will give them “additional benefits.” They may even recommend a plan that is not available in the call recipient’s area. The Centers for Medicare & Medicaid Services is taking notice of these sales tactics. But the agency’s regulations aimed at fighting misleading Medicare Advantage claims are not sitting well with a health insurance agents’ association, whose members are urged to sign a petition against these rules. Members of Health Agents for America are being asked to sign a petition on Change.org, asking CMS to reverse its requirements that licensed and certified independent agents record phone calls that result in enrolling a client into a Medicare Advantage or Medicare Part D prescription drug plan. The new call recording regulations would take effect October 1st.
According to the Federal Registry, in 2022, CMS reported 39,617 "complaints to Medicare" out of 29 million enrollments. This represents only 0.0013661% of the total enrollments made during the most recent open enrollment period. Most of these complaints originated from misleading TV commercials, encouraging Medicare beneficiaries to call a 1-800 number, according to the Agents and Brokers group. Third-party marketing organizations created many these misleading TV commercials, according to the group. The ads encouraged Medicare beneficiaries to call a toll-free number answered by a call center employee whose primary job was to encourage the beneficiary to change their existing Medicare health or drug plan to a plan that offered "additional benefits," when in fact the new plan may not cover their prescriptions or have their primary care provider in the plan's provider network. In some cases, the plans recommended were not available in the beneficiary's county or area. CMS addressed the complaints received from these ads by creating new regulations to protect Medicare beneficiaries. These new regulations require third-party marketing organizations, agents and brokers to record calls that may result in a new enrollment of a Medicare Advantage or prescription drug plan. Rules may discourage brokers, agentsThe new CMS call regulations will discourage many licensed and certified agents and brokers from representing Medicare Advantage and prescription drug plans, the Agents and Brokers group said. There are more than 100,000 licensed independent agents and brokers who certify each year to offer Medicare Part C and D plans. With fewer certified agents and brokers, the complaints to Medicare and workload may increase, not decrease, the group said. Fewer certified agents and brokers will also increase the workload of the estimated 15,000 State Health Insurance and Assistance Counselors nationwide, leaving beneficiaries with fewer options when considering Medicare health and drug plans. Additional concerns include HIPAA requirements to store data compliantly. The petition also recommends the CMS remove the licensed and certified independent agents and brokers from the definition of a third-party marketing organization and exempt the agents and brokers from the new call recording requirements. The call recording requirements raise some questions for HAFA members, said its president and CEO Ronnell Nolan. Those questions include:
“The whole idea behind this regulation is to make sure that folks who are on Medicare get the correct information and are being treated with the utmost respect,” she said. “The CMS rules were originally intended to go after these bad eggs that are calling these seniors and talking them into making changes that they shouldn't make, or that they don't even know that they're making. But Medicare agents go through extensive training to sell plans. This just seems like a slap in the face to the agent community.” ![]() |
Latest in Medicare Compliance - CMS Ruling Notification
Posted by www.psmbrokerage.com Admin on Wed, Jul 20, 2022 @ 03:23 PM
RE: Third- party Marketing OrganizationsOn May 9, 2022, CMS issued new requirements for third-party organizations (TPMOs) with an effective date of June 28, 2022 and an applicable date of January 1, 2023.
More details to come as we receive more updates and guidance. Helpful Resources: ![]() |
Tags: Online Enrollment, CMS, Compliance
CMS Announces New Cancer Care Model for Medicare Plans
Posted by www.psmbrokerage.com Admin on Wed, Jun 29, 2022 @ 03:15 PM
Medicare-enrolled physician group practices may apply through Sept. 30 to participate in a voluntary oncology care model beginning next July for five years, the Centers for Medicare & Medicaid Services announced today. Under the Enhanced Oncology Model, participating practices will take on financial and performance accountability for episodes of care surrounding systemic chemotherapy administration to Medicare patients with common cancer types. “We believe the Enhancing Oncology Model will incentivize participating oncology practices — including those in rural and underserved areas — to improve the provision of high quality, coordinated care that addresses patients’ social needs and improves patient and caregiver support,” said CMS Administrator Chiquita Brooks-LaSure. ![]() |
Tags: CMS, cancer insurance
Video: Referral Fees, Marketing Gifts and Inducements
Posted by www.psmbrokerage.com Admin on Wed, Jun 29, 2022 @ 10:40 AM
Check out the video here There is an exception to this rule which states that marketing representatives may provide gifts, prizes, or promotional items to beneficiaries for marketing purposes as long as:
Check out the video here It’s important to note that agents are not permitted to provide anything of value (e.g., gift card, flowers) to a consumer/member in exchange for a referral (i.e. contact information including name and telephone number/email). The key difference is the purpose of the gift. If it’s given in exchange for a referral, it’s not allowed. ![]() |
Tags: CMS, Compliance
YourMedicare CMS Lead-Generation Guidelines
Posted by www.psmbrokerage.com Admin on Thu, Jun 02, 2022 @ 11:17 AM
Confused about the October 8, 2021, Centers for Medicare & Medicaid Services’ (CMS) advisory regarding the marketing of Medicare Advantage (MA) and associated prescription drug (MAPD) plans? Here are a few key points to help demystify the latest update and help you comply with the rules for your lead-generation activities. ![]() |
Tags: CMS, Lead Generation, Compliance
CMS Unveils More User-Friendly Medicare Website
Posted by www.psmbrokerage.com Admin on Thu, May 19, 2022 @ 11:49 AM
The updated website, based on consumer feedback, prominently features timely initiatives and messages on the homepage and highlights key tasks and information most frequently sought by people with Medicare, people nearing Medicare eligibility, and their families.
Since 2021, CMS has introduced a number of enhancements to Medicare.gov to create a more welcoming and user-friendly experience. This week’s improvements redesign the Medicare.gov home page and, also, add more detailed pricing information about Medicare Supplement Insurance (Medigap) Policies that give individuals the information they need to compare Medigap plan costs and coverage options. CMS is committed to providing comprehensive and easily accessible information to support people with Medicare in their decision making. Additional improvements are planned for the next few months to streamline the Medicare Plan Finder landing page and the Medicare Account landing page, and align the look and feel with the new home page. Other updates to Medicare.gov throughout the past year include using simple language to answer complex questions people often have about Medicare coverage and step-by-step guidance to help people who are new to Medicare understand their coverage options and when they need to sign up. For example, a redesign of the "Get started with Medicare” section in the summer of 2021 guides users through a few questions to get personalized information for their unique situation to make it faster and easier to learn about Medicare and sign up. Updates to improve user-friendly navigation on the website include the implementation of a simple and modern consistent header in early 2021. CMS continues to use feedback from Medicare.gov users, along with human-centered design principles, to explore and plan future enhancements to the website and is committed to expanding personalization to create an optimized customer experience for people with Medicare and those who help them. Get CMS news at https://www.cms.gov/newsroom ![]() |
Tags: CMS
CMS Memo - 3rd Party Marketing - Oct. 8, 2021
Posted by www.psmbrokerage.com Admin on Tue, Oct 19, 2021 @ 11:01 AM
CMS Memo - 3rd Party Marketing - Oct. 8, 2021
A last-minute October surprise from CMS. Get ready for some lead disruption and intense carrier and CMS oversight this AEP.
MEMO:
CMS reminds Medicare Advantage Organizations (MAOs) that, under 42 CFR §§ 422.504(i), they are responsible for first tier, downstream or related entities (FDRs) adherence to all terms and conditions of the organization’s contract with CMS, including compliance with all applicable Medicare laws and regulations, when acting on the plan’s behalf. This includes, but is not limited to, the requirements that all marketing materials be submitted to CMS prior to use, pursuant to 42 CFR § 422.2261(a), and that Medicare Advantage (MA) plans may not mislead, confuse, or provide materially inaccurate information to current or potential enrollees, pursuant to 42 CFR 422.2262.
Advertisements intended to draw a beneficiary's attention to an MA plan or plans and include or address content regarding plan premiums, cost-sharing, or benefit information, including those not mentioning a specific plan by name (as well as instances where such advertisements are made on behalf of multiple MA organizations), are marketing as defined under 42 CFR §422.2260. Thus, these advertisements, as marketing materials, must be submitted to CMS prior to their use.
CMS is particularly concerned with national advertisements promoting MA plan benefits and cost savings, which are only available in limited service areas or for limited groups of enrollees, as well as using words and imagery that may confuse beneficiaries or cause them to believe the advertisement is coming directly from the government. In addition, CMS receives complaints from beneficiaries and caregivers that highlight sales tactics designed to rush or push beneficiaries into enrolling into a plan.
MA organizations are accountable and responsible for their marketing materials and activities, including marketing completed on a MA plan’s behalf by an FDR. Where such marketing materials and activities fail to meet our requirements, the MA plan may be subject to compliance or enforcement actions. CMS has identified and strongly encourages MAOs to adopt the following best practices:
• Utilizing outbound phone calls to beneficiaries, as opposed to letters, when complying with 42 CFR §422.2272(b) to establish and maintain a system for confirming that enrolled beneficiaries have, in fact, enrolled in the MA plan, and understand the rules applicable under the plan.
• Reviewing rapid disenrollments to identify trends associated with “bad players.” In
addition to recouping agent/broker compensation for rapid disenrollments as required
under 42 CFR §422.2274(d)(5)(ii)(A), recouping any administrative payments paid to an
FDR where rapid disenrollment occurs.
• Reviewing actual marketing and enrollment calls between beneficiaries and call centers/agents to ensure compliance with the communications and marketing requirements under 42 CFR Subpart V.
• Requiring FDRs to identify the origin of the enrollment lead (e.g., call in based on TV ad,
response to mailing).
• Recording the entire sales call in additional to all telephonic enrollments, as described
under Section 40.1.3 (Enrollment via Telephone) of Chapter 2 - Medicare Advantage
Enrollment and Disenrollment of the Managed Care Manual.
• Requiring FDRs to disclose all contracted third-party relationships. CMS is monitoring the “chain of enrollment,” which includes the marketing materials, lead generating activities, sales talks, and enrollment process to ensure these activities are completed in accordance with all applicable requirements. We are also working with other federal agencies regarding the appropriateness of the content of certain advertisements.
End Memo
Additional Updates:
- Medicare Marketing Guidelines
- MACRA 2020 What The Changes Mean For Agents
- What is AHIP Certification and How do I Get it?
Tags: CMS