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2011 CMS Medicare Symposium: Call Center Monitoring Presentation

Background. CMS monitors the following call centers for compliance with CMS standards:Part C and D current enrollee call centersPart C and D prospective enrollee call centersPharmacy technical help desks. Customer Service Standards. Per the Medicare Marketing Guidelines, sponsors must meet t

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2011 CMS Medicare Symposium: Call Center Monitoring Presentation

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    1. 2011 CMS Medicare Symposium: Call Center Monitoring Presentation December 15, 2011 Jennifer Shapiro, MPH Director, Division of Benefit Purchasing and Monitoring

    2. Background CMS monitors the following call centers for compliance with CMS standards: Part C and D current enrollee call centers Part C and D prospective enrollee call centers Pharmacy technical help desks

    3. Customer Service Standards Per the Medicare Marketing Guidelines, sponsors must meet the following standards: Average hold time – 2 minutes or less Average disconnect rate – 5% or less Provide accurate plan information Provide foreign language interpreters Provide TTY/TDD services

    4. Call Center Studies CMS has two call center studies: Timeliness Study – using current enrollee numbers and pharmacy technical helpdesk Accuracy & Accessibility Study – using prospective enrollee numbers Calls are placed by RTI, a contractor.

    5. Timeliness Study For current enrollee phone number and pharmacy technical help desk number, measures: Average hold time Average disconnect rate Study includes plans on marketing and enrollment sanctions and SNPs Study does NOT include PACE, Cost, Demo, and Employer Group/800 series-only plans

    6. Timeliness Study cont’d. Frequency & Timing Conducted during one month each quarter (4 months/year) Calls placed Monday-Friday from 8-8 in the time zone for the service area For pharmacy technical help desk, calls are placed Monday-Friday, 24 hours/day due to 24 hour pharmacies Number of calls per quarter varies based on enrollment (more enrollment = more calls)

    7. Timeliness Study cont’d. Results Available in HPMS at the end of the quarter. Compliance letters issued for violations of standards Pharmacy technical help desk performance is used for star ratings and quality bonus payments (QBPs)

    8. 2011 Compliance with Timeliness Requirements

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