Healthcare

CMS Marketing Regulations Compliance
HIPAA Privacy
OSHA
Organizational Compliance
Provider Pricing Audits

The Centers for Medicare & Medicaid Services (CMS) have set specific regulations on how insurance companies and their agents can market to potential health plan enrollees. The goal is to protect Medicare beneficiaries from deceptive or high-pressure marketing tactics by private insurance companies and their representatives during enrollment activities.

CMS conducts regular secret shopping activities to identify organizations that are not meeting its marketing and enrollment guidelines. Violations of CMS marketing standards can result in a range of sanctions, from hefty monetary penalties to voluntary suspension or termination from the program.

Are you confident that brokers, insurance agents and other marketing partners are operating within CMS guidelines? With over 200,000 beneficiaries becoming eligible for Medicare each month, the margin for error is high—especially since CMS has recently tripled its number of Secret Shopper interactions.

Proactively monitoring your sales and marketing activity will eliminate the danger of voluntary or imposed suspension of marketing activity and termination from the program. A Secret Shopper program will ensure:

• Your organization’s pre-enrollment marketing materials adhere to regulations
• Your sales agents are not practicing prohibited sales tactics
• All promotional activities and events are conducted in compliance with CMS marketing guidelines
• Accurate information is provided to all beneficiaries

TrendSource will design a custom Secret Shopping program to monitor your organization’s sales team and their level of compliance with CMS marketing guidelines. Our Secret Shoppers schedule face-to-face sales appointments and attend sales events. We monitor sales agents’ presentations for inaccurate information and prohibited sales tactics. We can also evaluate their overall beneficiary customer service and sales skills, and ensure sales agent’s knowledge of policies and procedures.
Ensuring compliance with CMS regulations has never been more important. Let TrendSource monitor your sales and marketing activity to identify any questionable compliance issues before CMS learns of them.

HIPAA sets very specific standards for keeping health information confidential. While onsite, our trained and experienced Mystery Patients can identify any obvious HIPAA violations during the course of their visit. They may overhear patient or client medical information, or witness patient records and documents in public view. The data we provide allows for immediate corrective action and prevents costly civil penalties, if reported.

The Occupational Safety and Health Act provides for regulatory intervention in instances where an employer puts workers at risk for illness or injury. Under your direction, our Mystery Patients can identify areas of concern and look for possible violations without compromising their identity. Avoid being reported for possible hazards in the workplace---and avoid a visit from OSHA to your facility.

You’ve invested valuable time and money in setting organizational policies and procedures, and ongoing staff training. How do you measure employee adherence with your company policies and procedures? Our telephone and onsite Secret Patients can monitor scripting, scheduling, referrals to the proper providers, records handling, patient follow-up and more. Mystery Patients can help you determine if staff members are adhering to company policies and procedures.

With the trend toward pricing transparency on the rise, providers and insurance organizations are getting more inquiries from consumers and insurance beneficiaries on their expected out-of-pocket costs for services. Recent studies suggest that incomplete or erroneous information is not out of the ordinary, creating serious customer service issues. TrendSource Mystery Patients can conduct pricing audits for insurance companies and health care organizations concerned about providing accurate information to potential clients.

"Plan responsibilities in complying with CMS marketing guidelines require plans to have proactive measures to avoid aggressive and misleading marketing tactics by agents and brokers. One of the measures Essence Healthcare implemented is a Secret Shopping Program.

The TrendSource Healthcare team has exhibited expertise and efficiency throughout the development of the Essence Healthcare Secret Shopping Program. TrendSource has been extremely accommodating and flexible, designing a custom program that allows us to proactively monitor our Sales Agents and ensure compliance with the CMS Marketing Guidelines. We highly recommend TrendSource to any organization seeking a competent and affordable resource to develop and implement a Secret Shopping Program."

DKG
Executive Vice President
Essence Healthcare Inc.
Maryland Heights, MO