Larry Shoemaker CEO, Clinebell Ltd.
The landscape of Medicare sales is constantly changing and the recent changes by CMS in 2024 are an extraordinary example of this. How can I adapt to the most recent changes? Adapting to regulatory changes and staying abreast of emerging trends in Medicare sales is crucial. We can find opportunities to improve our Medicare marketing. We will cover:
Three Major CMS Medicare Rule Changes That Matter Now
How Could CMS Audit us and What Will They Look For?
Solving the TPMO Disclosure Dilemma
The Best Defense is a Strong Offense
As an agent, and former internal auditor, I look at our business world with concerned eyes. CMS made several critical changes to how we do business during 2024. And CMS is proposing more changes for 2025 that could radically change how we do business. Already the industry is responding to these serious changes;
How should we respond to these changes? How can we make these changes work for us?
Three Major CMS Medicare Rule Changes That Matter Now
There are three changes we must pay attention to and their implications. First, call recording opens a door to monitoring how we do business and whether we are doing business “compliantly”. Secondly, the Scope of Appointment rules are very specific and measurable for compliance. Finally, the new TPMO Disclosure rule is another measurable requirement which is extremely difficult to comply with if an agent is licensed and contracted for very many service areas. Unless the agent has a program that can generate the two key numbers for every service area. There are three items about the TPMO Disclosure that concerned me. First – the negative tone of it. Secondly, the outrageous difficulty of providing accurate numbers for every single service area. I researched several counties and at 15 minutes per county, I was looking at 100 hours of research time. Finally, the idea of “disclosing” this much information on my website and in marketing ads was impossible. I would need 500 lines of information for all the counties I serve!
These changes have created a perfect audit opportunity.
The following may seem alarming; however, you can learn how to control each item and create a powerful sales process. These are opportunities.
CMS has delegated compliance oversight to the insurance companies and downline agencies. That could change anytime. Especially with the new tool of AI coupled with phone recordings. Phone recordings are easy to access, and AI can convert those recordings into text that can be scanned for key words and phrases of interest to an auditor. Now, CMS can audit for compliance “issues” easily and cost-effectively.
How Could CMS Audit us and What Will They Look For?
How could CMS audit us and what might they look for? And how could we defend ourselves?
CMS can demand access to our call recordings and our files. First, they would set up a checklist of items to look for in a sample of recordings. Then they would list the recordings and compare them to our phone records. Do we have recordings of conversations with our clients? Are we missing any? Check. Is the TPMO disclosure present within the first minute and does it have the correct information? Check and check. Is the Scope of Appointment explained and signing arranged for? Check and Check. Is the Scope of Appointment in the file; what is the signature date/time? Was the next appointment 48 hours or more after the SOA signature date/time? Check and check. These are the easily measured items. Next, what did we discuss? The audit “rules” get fuzzier here, yet there are plenty of things an auditor may look for. Were there any HIPPA or PHI violations? Did we discuss health issues that CMS deems inappropriate? Did we discuss matters “out-of-scope”? You know the kinds of things I am talking about. Check, check, check….!.
The Best Defense is a Strong Offense
We can use call recordings to evaluate how we conduct our client conversations and refine our conversational practices. Also, how we present and explain the TPMO Disclosure, Scope of Appointment and other Medicare subjects.
Also, we must control our use of call recordings to assure we are compliant. Like it or not, we must separate our business from personal calls. It may seem awkward, however our friends and family will understand our need to separate business from personal calls.
Some things I have discussed are relatively easy to control. However, the TPMO Disclosure has been a real thorn for agents. Aside from being an obvious advertisement for Medicare.gov and SHIP, it implies we haven’t effectively prepared for our clients. Why say this to clients? Because we can be audited and then?
Should I wing it and guess the number of organizations and plans I represent in various service areas? That is not something to argue with auditors. I know. Auditors are rule driven and “the rules are the rules”. This is the problem.
Fortunately, there is a solution. We converted the TPMO Disclosure into a TPMO Disclosure Sales Tool. The Tool starts with the Disclosure for the client’s service area, with the correct information for indicated service area. It then moves into a discussion of the carriers and plan types the Agent works with in that service area. For a working example, go to “https://tpmo.clinebell.com/?npn=2218886”
A link like this one can be embedded on websites and print media as a clickable link or a QR code. Either way, it is space efficient and allows for full, accurate disclosure for all service areas. Try it! You’ll like it! Just fill out the contact form and get on our waiting list.