By Joshua Brooker Starting Oct. 1, the Centers for Medicare and Medicaid Services will require health insurance agents and brokers to record all Medicare-related phone calls. At face value, having a recording of a call sounds like a great way to catch bad actors who misinform seniors about their options pertaining to Medicare. Here is my question to you, though: If I were to ask you to start recording all calls tomorrow, and do so securely as well as securely store the calls for 10 years, how would you do it? If your answer is, "I'm not sure," then we have a problem. Because that is exactly what the government is doing. They have advised the insurance agent and broker community, of which there are 100,000 self-employed mom-and-pop agencies across the country helping Americans, to record all calls but provided no guidance or support to do so. Why is this happening?Whether an individual is nearing age 65, or already has been on Medicare for years, there is no denying the onslaught of information they receive every day about Medicare, the plans they have access to, and the push for them to "act now.” According to the Federal Registry, in 2022, CMS reported 39,617 "complaints to Medicare" related to misinformation. This is out of 29 million enrollments. This represents only 0.0013661% of the total enrollments made during the most recent open enrollment period. Even though the complaints represent such a small number of seniors overall, CMS is trying to make strides toward fixing two things:
Consumers want to know who will receive their information upon filling out a form online or calling a toll-free number. Consumers also want to be confident that the broadest amount of plans are considered before a recommendation is made. CMS solution: proactive disclosureIn an effort to address Concern No. 1, CMS is requiring all marketing companies, as well as agents and brokers to state on their website and in the first 60 seconds of each phone call that "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." When a senior wants a local representative who is licensed in their state, certified to talk about Medicare, and understands the nuances of the local health systems and insurance plan options, they are looking for a resource beyond Medicare.gov and/or 1-800-MEDICARE. This disclosure does not address seniors’ underlying concerns. Another issue with this disclosure is that it doesn't tell the consumer whether the person on the line is a tethered/captive insurance agent, a marketing/lead generation company, or an untethered independent broker. Nor does it tell consumers the scope of options available to the consumer. If a given county has 70 plans available, and the person on the other end of the line has access to three plans, I think that there is a cause for disclosure. That said, some plans tied to special needs, only available only to captive agents might cause someone to have 65 plans available. Both scenarios require the same disclosure, and while the former (three plans) is alarming, the latter (65 plans) is understandable. CMS solution: call recordingAlthough CMS is hopeful that disclosure will inform individuals about their options, the agency also requires all tethered and untethered agents as well as lead generation companies to record calls. Actually, tethered agents tied to insurance company call centers, and lead generation companies already have this requirement. The May 9, 2022, rule added independent, untethered brokers to this recording requirement. Related Article: Call Recording Making Your Head Spin? As we have discussed, independent brokers are untethered insurance brokers who have the broadest plans from which to make recommendations, are licensed to interpret insurance laws, and do not operate as middlemen who sell your information like lead generators for other tethered or insurance companies. Untethered brokers are small businesses entrenched in their communities whose clients come from many sources, such as current clients, other insurance brokers, financial advisors, employers and human resource directors. Issue #1: small business requirements According to the Bureau of Labor Statistics, a broker's median wage is $49,840 per year. They aren't the upper crust of the insurance industry who can receive seven-figure salaries. Rather, as an individual in their community, they are being required to seek and deploy software to record all calls related to Medicare. The government failed to consider the limited resources of these individuals, and neither larger agencies nor insurance companies are tasked with providing support. Instead, the burden falls on the individual broker who must find software, set it up, record all calls, store all calls and make them available to regulators at a moment's notice, all while being secure in the process. When laws are passed by government agencies, if they are a burden to small businesses, they must make accommodations for those entities that are impacted the most. Not only are they adding a burden for the broker community to add compliant software, but they are also requiring that same agent or broker to tell every person they speak to on the phone to get their needs met elsewhere (medicare.gov and 1-800-MEDICARE). Issue #2: risking senior data Another issue to consider is the likelihood of compromised senior data. Alissa Knight, a partner at Knight Ink Media, is a chief information security officer and cybersecurity expert. She was a keynote speaker at a national Health Information and Management Systems conference. On a recent podcast, she said, "Electronic health records are worth 1,000 times more than a U.S. credit card number." She went on to explain, that if your credit card is stolen, your bank can send you a new card and you're fine. If your health history is compromised (accessed from one of these storage sites) and put on the dark web to sell, "how easy it is to get new health history sent to you in the mail? You can't. It's gone. If I want to figure out how to kill Larry, I find his protected health information, and I find out he is allergic to bee stings, I go after him with some bumblebees." In a phone call, not only might a recording include information about the individual on the phone, but seniors routinely talk about their spouses, kids, grandkids and other individuals. All of these could open up calls to not one, but multiple data points being at risk. Knight said health data is "such a lucrative business to be in." Obviously, she is looking at ransomware attacks. She goes on to state, that if a hacker is "targeting something like a Cerner EHR system [like data stored by a hospital or insurance company], that may be very well protected and very secure." If there is a less secure system outside of these secure programs, "where do you think I'm going to target as a hacker? I'm going to target the less secure. I'm going after the path of least resistance." Medicare represents more than 60 million seniors. Without defined policy and infrastructure in place, brokers are the path of least resistance. With 100,000 agents and brokers trying to figure out how to comply, this risk for anyone is dangerous. The current requirement to record calls is in the spirit of helping beneficiaries. We worry that the risk of senior data being exposed egregiously outweighs the risks of not recording calls. RecommendationsFirst, we'd like to address the spirit of the law. As independent brokers who have more than 50 insurance company contracts, and are entrenched in our community, we stand by regulations that serve the consumer’s best interest. At the end of the day, we often must address the same misinformation and complaints that Medicare deals with directly, and we work on the front lines to get Medicare right. This is why we are commenting on this rule. And, rather than pointing fingers, we offer real-world solutions.
Some tethered contracts require the agent to not get appointed to plans not available through the insurer, or their dedicated system. These clauses should be known to help identify tethered entities. This rework would tell the consumer who is receiving their data and which options the company is presenting against the total options of the market. Joshua Brooker, REBC, ABHP, ASFC, is principal at PA Health Advocates, Lancaster, Pa. He is a member of the National Association of Health Underwriters and Health Agents for America.
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Medicare Blog | Medicare News | Medicare Information
Commentary: CMS Medicare recording requirement could risk senior data
Posted by www.psmbrokerage.com Admin on Wed, Sep 14, 2022 @ 10:55 AM
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Tags: CMS, Compliance, call recording
YourMedicare Solutions for CMS's Call Recording & Disclaimer Rules
Posted by www.psmbrokerage.com Admin on Mon, Sep 12, 2022 @ 01:33 PM
As a friendly reminder, Precision Senior Marketing provides smart and efficient ways for you to stay compliant this AEP. In partnership with two of the industry’s leading technology companies, MyMedicareBot and SunFire, you have access to CMS-compliant call recording solutions.
You can also learn more by attending one of our weekly webinars. View schedule.
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Tags: Medicare Advantage, AEP, SunFireMatrix, Compliance, MyMedicareBot, call recording
4 Racing Tips to Help You Win This AEP
Posted by www.psmbrokerage.com Admin on Fri, Sep 09, 2022 @ 11:13 AM
4 Racing Tips to Help You Win This AEP
TIP #1: STUDY THE COURSE
Keep your book of business organized from day one. Know the plans and products available to you so that you’ll have time to map out a strategy. The more you can prepare now, ahead of Oct. 15, the less you’ll be scrambling at go-time. It’s also important to lighten your load at home. Knowing your work will become much busier in October can be helpful when planning your work-life balance for the next few months. Consider any potential personal commitments or important family holidays — like Thanksgiving — now. Plan ahead and minimize your stress during AEP. TIP #2: START YOUR ENGINES
Friendly, pre-AEP reminders to Medicare beneficiaries are a great way to get ahead. Just remember: Communications can’t include anything specific regarding plans, like pricing or benefit details. AEP lasts 54 days. It’s a race to Dec. 7, where your focus could be the difference between achieving your goals and not. How are you planning to fuel your growth this year with a goal of 25% YoY growth in your submitted app count? TIP #3 STAY EFFICIENT
Leverage available technology for important services like scheduling and comparing plans. You have access to the YourMedicare Enrollment Center — a multicarrier platform where agents can compare plans, get quotes and enroll their clients. Agents have turned to the YourMedicare Enrollment Center as their “goto” platform for enrolling beneficiaries into Medicare Advantage and Part D prescription drug plans. And with AEP coming up, using the YourMedicare Enrollment Center is a double win: For every submitted application mad through the platform, YourMedicare donates at least 10 meals to Feeding America. With more than 550,000 meals donated already, YourMedicare is well on its way to reaching its goal of donating 1 million meals in 2022. Agents also have access to YourFMO.com, a one-stop shop for growth with Medicare TIP #4 ALWAYS LOOK AHEAD
Remember: Your contacts are also someone else’s prospects. If you’re not planning ahead, chances are, someone else is. Year-round communication can help you stay top of mind. Try things like birthday cards, newsletters or quarterly mailers. The simple act of following up can help create lifelong customers and relationships. And remember to keep preparing for AEP all year long. When one AEP ends (or even during this AEP), start thinking about the next. Mastering the art of the AEP sale comes with practice. As you find what serves the client’s best interest, you’ll build on your success and your business will thrive. Have a great 2023 AEP! ![]() |
Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
Coming Soon for AEP! YourMedicareSunFire Recording Capabilities
Posted by www.psmbrokerage.com Admin on Fri, Sep 09, 2022 @ 10:29 AM
On that day, the Centers for Medicare and Medicaid Services (CMS) released its 2023 Final Rule, and in this extensive document, there are two important guidelines we’d like to highlight in a more simplified manner. New Required Disclaimer
Aside from that, this disclaimer needs to be added to any previously approved materials and resubmitted to CMS for approval. Calls With Beneficiaries Must Be Recorded Agents making calls to beneficiaries must record ALL calls in their entirety. In addition, This includes calls that are part of the chain of enrollment into a Medicare Advantage or This rule applies to telephonic conversations only, not face-to-face meetings. The YourMedicare team was well aware of this change and immediately took action in
This is just the beginning of what is to come. As new information becomes available, we’ll keep you updated on all new enhancements, news and more specific details ![]() |
Tags: Medicare Advantage, Medicare Part D, Prescription Drugs, AEP, SunFireMatrix, Compliance, 2023, call recording
Set for Launch - Compliance Tips for AEP
Posted by www.psmbrokerage.com Admin on Thu, Sep 08, 2022 @ 12:39 PM
As you are well aware, agents will juggle vast amounts of activity during this time. Unintended actions may be a pathway to making compliance mistakes, which may derail the AEP application process. Before we lift off into a new AEP season, let's consider a few significant points related to compliance in order to remain on the right trajectory for a successful launch. Scope of Appointments detail the exact topics beneficiaries would like to discuss with an agent. CMS requires agents to have beneficiaries sign an SOA prior to discussing Medicare Advantage or Part D Prescription drug plans. Every appointment with a beneficiary requires an SOA and these forms must be kept on file for 10 years, even if the appointment doesn't result in a sale. Also, starting this year, a new CMS ruling requires agents to read a disclaimer to all potential clients at the beginning of a sales call. Reading this during the SOA process is an optimal time for this disclosure. These calls must be recorded and stored for 10 years.
Before agents can help a client with a Medicare plan, they must know the physicians and the specialists a client sees for their healthcare services. Many beneficiaries are happy with their healthcare providers and don't want to change. Compare their current providers with the providers in the plan's network to ensure there isn't a disruption in services. It's important to review a client's prescriptions in order to help them clearly understand the cost of drugs for a particular plan. An unexpected increase in drug prices can quickly turn an exceptional client experience into an unsatisfactory one. Make sure to review enrollment data with your clients, this way, if there is an error, you can fix it on the spot rather than having the application returned. Reviewing a client's prescriptions will ensure they are given options for the most comprehensive coverage for their individual needs. A Summary of Benefits must be provided to beneficiaries at the time of enrollment to provide clarity regarding coverage. Although beneficiaries will receive a hard copy of this document after enrollment, agents must summarize key features such as covered benefits and cost sharing. The Summary of Benefits needs to be thoroughly discussed prior to signature-collection and verification of intent-to enroll. Agents are certainly busy during AEP and sometimes put off submitting an application to a carrier. This can result in the application not being submitted in the required 24-48 hour time frame. An agent's primary responsibility is to ensure a clients' insurance needs are met. It's important to take the extra time and double check to make sure your clients' applications have been taken care of within this time frame. ![]() |
Tags: Medicare Advantage, Medicare Part D, Prescription Drugs, AEP, Compliance, 2023
Celebrity Medicare Sales Pitches Are Toned Down After Scrutiny
Posted by www.psmbrokerage.com Admin on Wed, Sep 07, 2022 @ 04:25 PM
Soaring complaints and aggressive sales efforts result in tighter rules from regulatorsIf it’s football season, you can count on seeing Joe Namath on television, along with William Shatner and Jimmie “J J” Walker. They are the most prominent pitchmen for what has become an annual fall selling frenzy for Medicare Advantage policies. After a surge in consumer complaints, and stiffer government rules, the sales pitches will likely be tamer this year. If there is confusion, “we’ll change things so it satisfies everybody and eliminates the confusion,” said Mr. Shatner, best known for his role as Captain Kirk in the “Star Trek” franchise The federal Centers for Medicare and Medicaid Services toughened its oversight after consumer marketing complaints surged 165% last year to 41,136 compared with 2020. Brokerages, agents and other marketing businesses tried to convince Medicare recipients to switch plans, with promises of perks in their new plans such as home-delivered meals, rides to doctors’ appointments and cash. In some cases, beneficiaries would effectively pay for the perks with more-limited provider networks, forcing them to find new doctors, regulators say. The celebrity pitchmen haven’t been accused of violating any rules. The aggressive sales efforts by marketers are the result of billions invested by private-equity firms, financial-services companies and stock-market investors into virtual call centers, internet-based lead-origination firms and other marketing businesses over the past several years. The investors all focused on the annual sign-up period for Medicare Advantage plans, which are an alternative to the traditional fee-for-service Medicare plans. Enrollment in the plans, which are offered by private insurers and paid for by the government, grew 8% last year to 28.4 million in 2022, according to the Kaiser Family Foundation. Consumers can sign up for new plans every year, making them a prime opportunity to generate sales commissions for brokers. “Seniors are being bombarded,” said Ron Henderson, a deputy insurance commissioner in Louisiana. The sign-up period runs from Oct. 15 to Dec. 7. The stiffer rules are targeted at marketers that sell policies on behalf of health insurers. They will need to disclose more to their customers while CMS clarified that insurers will be responsible for what their marketers say. ![]() |
Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
Medicare 2023: What Agents and Clients Need to Know
Posted by www.psmbrokerage.com Admin on Wed, Sep 07, 2022 @ 04:07 PM
Many of the general rules governing Medicare remain the same, said Harriett, though some plans and benefits will change. Some rules are specific to agents while others may be helpful to their clients. However, Harriett said, there are always a few general rules agents need to know when dealing with clients. Here is an overview of what agents need to know for 2023, according to Harriett: General enrollment period dates have changedThere are a number of reasons someone did not enroll in Medicare when he or she was first eligible. In that case, most reasons qualify them to enroll during a Special Election Period, Harriett said. But some people who did not enroll when they were first eligible and had no special election period were restricted to enroll only between Jan. 1-March 31 of each year, with their effective enrollment date beginning July 1. This year, things have changed. For those paying for Medicare Part A, and for those enrolling in Part B, Harriett said, their effective date will be the first day of the month after they enroll. Applicable penalties will still apply. Coverage gap continues to get smallerThe Medicare Part D Prescription Drug program has always had a phase, known as the coverage gap (previously known as the “doughnut hole”). This is a period in prescription-drug coverage when a client’s coverage is reduced if costs escalate to a certain point, and the client pays more for a period of time. Since its inception, Harriett said, the coverage gap has been a point of political contention, with several attempts over the years to fix the burdens this gap created for those who need expensive drugs. In the last few years, Medicare has broadened the definition of “True out of Pocket Costs,” including how the gap is calculated. Now, once in the coverage gap, drug manufacturers pay 70% of the cost of a drug, the insurer pays 5%, and the client covers 25%. But 100% of those costs count toward the beneficiary’s total spending, which gets them out of the gap more quickly and into catastrophic coverage. For example, Harriett explained, a drug with a true cost of $100 in the coverage gap would be paid as follows: The manufacturer covers $70, and the insurance company pays $5. The beneficiary is responsible for $25. But the Explanation of Benefits will show that the beneficiary has paid $100 in out-of-pocket costs. Disclosures must increaseThe huge number of marketing calls from call centers in recent years has led to a striking increase in the number of complaints to the Centers for Medicare and Medicaid Services (CMS) regarding AEP enrollments. Because of this, there have been a few alterations to the rules, Harriett said. This year, marketing organizations must disclose when and if their information is being transferred to a licensed agent (if they were not talking with one originally). Also, there is a new general disclaimer, which must be read to all beneficiaries within the first minute of their telephone call to agents. A full copy of this disclaimer can be found in the insurance company’s Medicare Advantage/PDP compliance bulletins, Harriet said. Marketing, enrollment calls must be recordedAs the rules stand today, all calls that market and enroll beneficiaries in Centers for Medicare and Medicaid Services (CMS)-regulated Medicare products must be recorded from beginning to end and stored safely and securely for at least 10 years. “How this will look in the future is anyone’s guess as it is being challenged by a number of organizations,” Harriett pointed out, “but it appears that for now, the rule is here and will be in place. So, if you are going to be marketing products during AEP, be sure to set up a recording system. If you won’t be marketing, be sure to tell your clients they will be recorded when they talk with someone about it.” The call recording is a big change, Harriett said. But apart from the general change in Medicare costs or numbers (the bulk of which will most likely not be published until at least the end of October), many things in Medicare carry over from this year, Harriett said. “But that does not mean you or your clients should relax,” she said, adding “Always check over benefits with your clients. Prescription drug plans and Medicare Advantage plans change each year. And next year’s plan may not meet your client’s health or financial needs for 2023.” Always use this opportunity to talk to everyone about it.”
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Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
3 ways to navigate the new CMS call recording rules
Posted by www.psmbrokerage.com Admin on Thu, Sep 01, 2022 @ 04:51 PM
It’s 2008, and the Centers for Medicare & Medicaid Services just published what quickly would be deemed as “industry-shaking” new Medicare communication and marketing guidelines. From rules regarding scopes of appointment and other requirements intended to clean up poor business practices, many marketers and agents were beside themselves. A palpable panic began to emerge as we scrambled to understand the implications of these new rules to our businesses, our client engagements and our future prospects. Let’s face it – we were living perfectly fine before these rules were published and our industry was riding high. But these new rules weren’t just some one-off requirement. They were a watershed moment for our industry, and they started a cascade of new guidelines from CMS designed to protect consumers and help agents maintain credibility, transparency and trust with those very consumers. Fast forward to today and we find ourselves in a similar position with CMS’s recently published requirements regarding call recordings. As in 2008, I’ve received many of the same questions: “How will this impact me and my business?” “What tools or resources are available to help me do this?” and “What does this mean for engagements with existing clients versus prospective clients?” These are perfectly understandable questions for agents to ask. Compounding the confusion and hard feelings is the notion that CMS likely implemented these new rules in reaction to one particular bad actor and now we all have to deal with the repercussions (not to mention the vagueness of the rules themselves and their release so close to the all-important annual enrollment period selling season). Many of us remember a time when door-knocking dominated our industry, and face-to-face interaction played a vital role in developing client trust. But as we’ve shifted to telephone and e-selling approaches, you can’t help but feel as though today’s agents are being punished for the natural evolution of our industry and consumer engagement. However, rather than continue to bemoan yet another layer of compliance, it’s important to see the opportunity in front of us. Simply put, we always can do better. The biggest threat to our business always has been the commoditization of the agent-consumer relationship, and these rules help ensure that we continue to be perceived and operate as the trusted advisors we need to be.
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Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
Gearing Up for AEP - Compliance Bulletin
Posted by www.psmbrokerage.com Admin on Tue, Aug 23, 2022 @ 01:36 PM
As you'll recall, the annual enrollment period is a time when your clients can essentially make any change they are eligible for. Among other things, these changes may include enrolling in Medicare Advantage for the first time, switching from one Medicare Advantage plan to another, or joining a Medicare prescription drug plan. As you may know, AEP only lasts from October 15 through December 7th. This only gives you roughly seven and a half weeks to close on sales. With such a small window of time to enroll potential clients, it's important to take care of all your contracting, certifications, and training as soon as possible. Here are a few important points to consider before you can jump into AEP.
Now that we've gotten the general information out of the way, let's look into a few tips regarding what to avoid saying to current and potential clients in order to stay CMS compliant. "Free premiums!" "Is your spouse eligible for Medicare?" - "How about your friends?" - "Can I have their number so I can call them?" "If you're liking this Medicare plan, you should check out this life insurance plan." "Let me get your contact information so that you are able to come to my event." "While you're waiting for your doctor, let me tell you about your Medicare options." As you are well aware, there are many other requirements to consider in order to remain CMS compliant. Our aim today was to help you gear up as October 15th quickly approaches. Remember to complete your contracting and certifications, order your supplies, read up on any compliance changes, and set your goals. Thanks for tuning in, and we'll see you next month with some more compliance tips. We hope you find this information informative and we are always happy to assist with any questions. You can review a video summary of this information here. ![]() |
Tags: Medicare Advantage, Medicare Part D, Prescription Drugs, AEP, Compliance, 2023
Sunfire: Integrated Telephony for Field Agents
Posted by www.psmbrokerage.com Admin on Mon, Aug 15, 2022 @ 02:16 PM
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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Tags: Medicare Advantage, CMS, AEP, SunFireMatrix, Compliance, 2023