We’re quickly barreling toward the Centers for Medicare and Medicaid Services (CMS) call center monitoring period, which will ramp up in February 2019 with its Accuracy & Accessibility Study (the Timeliness Study is performed quarterly). CMS developed its 5-star rating system to measure the quality of CMS’s Medicare Advantage (MA) Plans and Medicare Prescription Drug Plans (Part C and Part D, respectively) to ensure its beneficiaries have access to affordable, high-quality coverage.

 

Where Does Call Center Monitoring Figure In?

For 2019, plans that cover health services (Part C) are scored based on 34 measures that fall into five categories:

  1. Staying Healthy: Screenings, Tests, and Vaccines
  2. Managing Chronic (Long-Term) Conditions
  3. Member Experiences with Health Plan
  4. Member Complaints and Changes in the Health Plan’s Performance
  5. Health Plan Customer Service

For 2019, plans that cover prescription drug services (Part D) are scored based on 14 measures that fall into four categories:

  1. Drug Plan Customer Services
  2. Member Complaints and Changes in the Drug Plan’s Performance
  3. Member Experience with the Drug Plan
  4. Drug Safety and Accuracy of Drug Pricing

Both Part C and D have categories dedicated to customer service that are broken down further to include how the plan handles member appeals and foreign language interpreter and TTY availability. To measure foreign language interpreter and TTY operator availability, CMS conducts test calls to determine the percentage of time these services were available to a prospective beneficiary when needed. In addition to availability, the tester also confirms that prospective beneficiaries are receiving an accurate and complete interpretation of plan benefits.

The scores, ranging on a scale from 1 to 5, are determined based on set criteria.

 

CMS Star Ratings: What’s the Big Deal?

Now that we know how call center monitoring fits into CMS’s star rating system, it’s important to recap why receiving a high score is so crucial:

  • Some MA plans receive quality bonus payments and/or rebates that correspond with their star rating. For bonus payments, a higher rating means they are able to offer their beneficiaries either a lower premium or increased supplemental benefits. For rebates, a higher rating means they are able to offer their beneficiaries increased supplemental benefits.
  • Star ratings are published on the Medicare Pathfinder (MP). If a plan receives a score of fewer than 3 stars for three years in a row, the plan is flagged with a low-performing icon.
  • MA plans that receive a 5-star rating can enroll beneficiaries and market their products year-round.

Lots of planning, organization, and training go into preparing for CMS test calls. To make sure all that preparation doesn’t go to waste and you’re up to speed for 2019, we’ve put together three resources to assist you in achieving success.

 

1. Part C and D Performance Data

There is a host of information kept on the CMS Part C and D Performance Data page that you’d be hard-pressed to analyze all in one sitting. But here are some highlights:

  • Star Ratings User Call slides: A helpful deck that quickly outlines the changes to the star rating program for the upcoming year.
  • Star Ratings Technical Notes: The technical notes, which can be found in the same ZIP file as the Part C and D Medicare Star Rating Data, comprise over 150 pages of content. Most of it, like the name suggests, is very technical, but it does go into great detail about each measure and the methodology used to score and assign stars.
  • Part and D Medicare Star Ratings Data: The pièce de résistance, this hefty zip file contains the raw data for all measures collected for every health plan monitored. (Note: not all plans will have a result for every measure.)
  • Results from previous years: The results from 2007 to the present are listed, which is helpful if you’d like to comb through the data to see how you stack up year after year.

 

2. HPMS Memos

Memos have largely been replaced by email, even in the most professional of settings. But they are still very much worth paying attention to, like in the case of CMS’s Health Plan Management System (HPMS) memos.

HPMS releases memos throughout the year, some of which contain specific information regarding star rating data, preparation, and instruction. While all the CMS star rating memos are worth reading, there are two that can’t be missed. First, the “Part C and Part D Call Center Monitoring — Guidance for Timeliness and Accuracy & Accessibility Studies” memo (released week of Nov. 26–30, 2018) covers the elements CMS will monitor. It outlines important definitions, where to access results, how and why to verify your call center phone numbers, and tips for success.

The second memo is actually … an email. But you can still find it mixed in with all the communications included on the HPMS Memos Archive. The “Call Center Monitoring — Availability of Performance Metrics for Accuracy and Accessibility Study” (released week of Aug. 6–10, 2018) email is handy because it notifies recipients of when performance metrics from the previous study will be available for review before they’re calculated into the final star rating. This gives plans the opportunity to review their scores and note any discrepancies before they’re published on the MP.

 

3. CLI’s Language Access and CMS Call Monitoring Guide

In order to attain 5 stars on the call center monitoring portion, you’ll need to partner with a language service provider that has experience working with CMS test calls — and the quality and speed to match.

At CLI, we’ve focused on CMS compliance since 2008, and have developed a series of materials and protocols to assist not only our clients in ensuring they’re prepped for CMS test call season, but also our interpreters. We know how important quality and timeliness are to you and your members, and that’s why we’ve assembled our Language Access and CMS Call Monitoring guide. The guide reviews essential information on star rating methodology and calculations, as well as our internal CMS success program. It’s a must for anyone looking to maintain or increase their star rating and provide quality care to their member base.

Have any questions? Please contact us — we’d love to hear from you and talk about how we can help you execute test calls with precision!