Regulatory Headwinds: CMS Compliance and Oversight

Regulatory Headwinds

In remarks at the recent RISE National Conference earlier this month, the inspector general of HHS, Christi Grimm, reiterated the department's focus on Medicare Advantage compliance. And in proposed rules released by CMS last December, it's clear that third-party marketing organizations (TPMOs), broker networks, and marketing/sales practices in general will garner more scrutiny.

A Trusted Thread of Auditable Data

There's never been a more applicable time to evaluate Medicare Advantage-specific technology that incorporates compliance requirements from the Medicare Managed Care Manual's Chapter 2 & 3 guidance.Since our inception in 2006, MA organizations including start-ups, regional, provider-sponsored, Blues/national plans have relied on Cavulus technology to unify messaging, bolster compliance efforts, and gain complete visibility into every aspect from marketing touch points to communication with CMS. Our clients extend our platform to their internal & 3rd party call centers, direct sales staffs, broker networks and more to maintain control and capture a complete and easily auditable snapshot. This includes compliance features such as:

  • Scope of Appointment Capture
  • Permission-to-Contact Tracking
  • Dynamic, CMS-Approved Call Scripting
  • Validation of CMS-Required Data on Enrollment Forms
  • CMS Timelines Enforcement for Processing, Submissions, and Letters
  • CMS-Approved Model and Non-Model Member Correspondence

Talk with us about compliant Medicare Advantage member acquisition and enrollment technology.

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