Each year, the Centers for Medicare and Medicaid Services (CMS) conduct a Call Center Monitoring Study.
CMS performs the study between February and June by placing calls to Medicare Part C and D call centers to - among other thing - evaluate performance in assisting Limited English Proficient (LEP) and Deaf and Hard of Hearing callers.
A portion of the study measures the availability of an interpreter, as well as the accuracy of information provided by the customer-service agent. This portion is called the Accuracy and Accessibility Study.
There are massive financial and marketing implications to the CMS study, as plans earning four and five stars stand to net additional dollars in Quality Bonus Payments, as well as valuable opportunities to shop their plans. (Five-star plans are afforded the opportunity to enroll members throughout the year.)
Given these high stakes, it’s only natural that misconceptions would emerge as plans aim for the highest score possible.
Below are three misconceptions that we hear most often. We’ve researched each of these suppositions and are glad to explain the reality behind each of them.
1. Failing the accuracy portion of the CMS Study will ruin a plan’s Star Rating.
This is not correct. The accuracy portion does not impact the Star Rating. Instead, it is a compliance requirement. Compliance actions only occur if the plan’s overall measure is below the 75 percent compliance cut point.
Accessibility (i.e., a connection to an interpreter and then an answer to the introductory question within eight minutes) does impact Star Ratings.
So if an accuracy failure does not directly impact a plan’s Star Rating, what does it impact?
The accuracy component of the CMS Exam is a compliance requirement. Plans must achieve 75 percent or better on the accuracy component to avoid specific compliance-related action from CMS. This is described in the annual CMS memo to plans.
2. A call is considered a failure if a connection is made to an interpreter within eight minutes, but the call times out during the question-and-answer period.
In this instance, the accessibility measure would be considered “complete”; however, if the call times out because it takes longer than seven minutes for one of the three questions to be answered, the auditor will hang up. The accuracy portion of the specific call may be considered a failure in this instance.
3. Interpreters have to be located in the United States to interpret for a Medicare plan.
CMS does not prohibit Medicare plans from partnering with a global interpreter workforce. There is no domestic-only requirement for interpreters.
LanguageLine’s Guide to the CMS Study
Each year, LanguageLine Solutions publishes a Guide to the CMS Call Center Monitoring Study. The 2019 guide will help you:
- Understand CMS requirements and their impact on your organization
- Educate your customer-service agents on CMS Study requirements and how to best prepare
- Optimize support from LanguageLine, which for years has been a trusted partner to 4- and 5-star Medicare Part C and D plans.
We invite you to download LanguageLine’s Guide to the CMS Call Center Monitoring Study: 2019 Edition.