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Top Compliance Mistakes in Home Visits for MA Agents

As RBI’s Director of Training and Compliance, I hear all the time from agents that have gotten into compliance trouble.  So here’s my shortlist of the biggest compliance mistakes in home visits for Medicare Advantage Agents.

Number 1: Failure to collect the Scope of Appointment before presenting the product.

As odd as this sounds, many agents still struggle with the SOA requirements. The CMS requirement is to obtain scope of appointment at minimum 48 hours prior to the appointment whenever practicable. Many agents still fail to complete one prior to the appointment.

Compliance Mistakes in Home Visits

Here’s my shortlist of the 4 biggest compliance mistakes in home visits for Medicare Advantage Agents.

Number 2: Failure to complete a needs analysis.

Many agents view MA sales as an order taking exercise.

  1. Are your doctors covered?
  2. Are you drugs covered?
  3. Is the premium/copay less than what you have now?

While those are good questions to ask, you need to find out what is most important to the member. Find out what services they use most often. Are they worried more about premium or unforeseen costs? Do they plan to travel? If you do this step properly, you will avoid allegations and grievances by vetting them out on the front end.

Number 3: No Cross Sell of Other Products.

I still talk to agents every day that are very wary of cross selling any product during an MA appointment. Cross selling is perfectly fine as long as the products are agreed to on the SOA form. Hospital Indemnity pairs perfectly with MA plans and in many cases can double or more your first year commission on that member. Just remember you can only cross sell health related products. See our blog posts for more info. No Life, burial or annuity sales allowed in the same appointment.

Number 4: Did Not Ask for Referrals

There is a common compliance misconception going around regarding asking for referrals in appointments. In fact, several carriers have been training agents to never ask for a referral in an MA appointment. While soliciting names and phone numbers is prohibited, you can absolutely ask clients to refer their friends and family to you. Many agents leave only one business card and don’t follow up with a letter or even a call after enrollment. Leave at least 5 business cards at every appointment, even if you don’t enroll them and always include a few in any letters you send to your clients. Not only will you get some word-of-mouth marketing, but this ensures that you answer any lingering questions that otherwise may cost you in a disenrollment.

Are you concerned about compliance?  RBI is here to help! Our contracted agents get access to our support team, including Rob Bever, Director of Training and Compliance.  If you would like to get started today, click here to see a list of carriers.  You can also call and speak to the team or Rob directly, at 1-800-997-3107.

MA Compliance Requirements for Agencies

If you’ve ever wondered if you were following all the guidelines for compliance, you’re not alone. As the Director of Compliance for RB Insurance Group, I talk to agencies nearly every day that are struggling through a carrier audit, often bringing daily business to a grinding halt.  If you are nodding along, don’t panic!  We can help you build processes to get compliance under control.

That’s right, I’m the “FUN” guy in the office.

Compliance = fun right?

All MA carriers are audited for compliance by CMS every 3 years. Contracting with multiple carriers increases your chances that at some point you will be picked for a random agency compliance audit.  CMS requires the carriers to hold agencies accountable for the compliance of contracted agents and employees.

Are you an agency with no employees (besides yourself) and you still get certified every year and sell?  Rejoice, as much of this doesn’t apply to you.

Basic Requirements

The most commonly overlooked CMS requirements for FDR’s (First, Downline and Related Entities) not an exhaustive list.

OIG/SAM Exclusion Check

Upon hire and monthly thereafter you must check all employees, (even yourself), against both the OIG List of Excluded Individuals/Entities and SAM Excluded Persons List System (EPLS).

Most agencies know about the OIG (Office of Inspector General), but not the SAM (System for Award Management) requirement. The button looks like this:

You must keep records of the searches. Some carriers have a spreadsheet they want the tracking in, others want you to make one.

Regardless, it will need to include the basic information on all your employees/agents as well as dates of the checks. A sample Excel Spreadsheet will be made available to contracted agencies inside the Medicare Sales Engine.

CMS General Compliance and Fraud, Waste and Abuse Training (FWA).

GC/FWA training must be completed upon hire and annually thereafter. Every employee must complete it.

If you and all of your staff are licensed writing agents with all the carriers you represent, you’re in luck: it was included in your annual training and you do not have an additional requirement.

For everyone else, there are 3 ways to meet the requirement:

  • Have all your staff enroll in the MLN (Medicare Learning Network) and complete the courses and get the certificates.

  • Go over the CMS training in PDF form with all your staff and have them take the exam on paper, then generate the certificates.

  • Incorporate the CMS training information into your existing compliance training and testing, and generate your own certificates. (Not suggested and not accepted by all carriers.)

We can assist you in obtaining the required materials for this training, just give us a call at 1-800-997-3107.

You must also have:

  • Written Code of Conduct

  • Written Code of Ethics

  • Policies and Procedures manual that applies to Medicare Advantage and Medicare as a whole.

  • HIPAA Security Plan

  • Compliance Officer (yes, you have to have one)

  • A method for employees to report suspected FWA or other violations internally and anonymously.

There are a lot more requirements and details than I can get into in a short blog article, but this will get you started.

If you are currently the subject of a sales allegation, carrier audit, or just want to prepare so you aren’t scrambling to get compliant when you receive an audit notice, you can contact our office for assistance.

RB Insurance Group, LLC 1-800-997-3107

Appeals and Form CMS-1696, the Appointment of Representative

Humor me with this post. It deals with appeals.

Say your client Fred is really upset. He feels the prior authorization for his electric scooter should have been approved, but his Medicare Advantage carrier has denied it. It happens: Providers occasionally submit a weak authorization request and sometimes carriers might even make mistakes. When either of these happen, who do plan members like Fred turn to after a confusing conversation with customer service? He of course will call his insurance agent.

You can help your clients make an appeal with the Form CMS-1696. Image courtesy of iStock Photo

Medicare-agents-use-Form-CMS-1696

Back when I was young and foolish As a former carrier appeals supervisor, I know a few things about appeals. The following paragraphs assume you actually want to work with an appeal situation:

Start with customer service. A surprising number of issues might be resolved with a couple of calls. If your client isn’t comfortable on the phone or just can’t digest the information (this seems to be happening a lot recently), get on a 3-way call with him or her. Agents tend to be more attuned to customer service lingo.

If necessary you can help initiate step one in the process. An “organization determination” can even be done in advance to clarify if a procedure or service will be covered. If you have no luck with this, move to the more formal appeal process Level 1. A detailed overview of the steps through all levels of appeals is available here.

If your client is incapable of dealing with the process I suggest you become an unofficial advisor. Just note that carriers do not appreciate agents getting directly involved as the client’s representative in the formal appeal process unless you are a relative. It’s preferable that a client’s competent friend or family member become involved. You can coach the parties, but it’s not advisable that your agent name appear any documents. Your client can appoint a representative with a simple Form CMS-1696, which I’ve linked to right here. Include it with the rest of the appeal information.

I’ve utilized this form a few times on behalf of my older relatives who invariably buy their Medicare insurance from some other agent who does not return phone calls (We will deal with that type of unwelcome charity work in a future blog post).

For assistance with an appeal situation our affiliated agents can call me here at RBI. Just dial (800) 997 3107. I would not consider it charity work, so feel free to call or even email me.

Who are these Medicare Secret Shoppers?!

Secret Shoppers attend formal and informal sales events as well as educational events and even arrange agent home appointments where they use a fairly rigid reporting system to evaluate your performance (Take at look at it for yourself here). The AARP Bulletin even added information about growing demand for senior (that’s age 50 +) Secret Shoppers in an article posted years back.

Image courtesy of iStock

One of our affiliated agents in Arizona had several interesting “Shopper” encounters last AEP. After being supplied with many compliant leads via our Medicare Compare business reply cards (BRC) we mailed in conjunction with a national carrier, Bruce went about setting home appointments. One Monday afternoon he arrived promptly at the beneficiary’s home in Phoenix and presented an MA plan. No luck on that sale.

A few days later he called a cell phone number on a new BRC that had arrived with a different name and number, but the same address as Monday’s presentation. Bruce did his thing, again with no sale, and went on his way, but not before the prospect had said something about her roommate being the first respondent and that she enjoyed hearing from Bruce herself about her Medicare options.

On to the next week. You guessed it! A third prospect arrived via BRC with a different name and cell phone number, but same address. Bruce was getting a little irked due to the amount of time he was wasting, so he just dropped off a packet with apologies that he had an emergency at home that needed his immediate attention.

Three different Shoppers were using the same house. Bruce is a a very thorough agent, so none of the Shoppers reported deficiencies. On the contrary, he got a gold star for his compliance. And it turned out that the three Shoppers were employed on behalf of the very same carrier who was co-sponsoring our BRC mailers!

As an agent, how do you prepare for being “Shopped”? Use carrier-supplied flip charts or recorded links to play back for your prospect. Doing this will cover about 75 percent of the mundane, but nonetheless mandated information. Go over all the benefit lines in the summary of benefits.

I also recommend watching out for any question a prospect may ask about the “best plan” because secret shoppers always pull out that old chestnut when they reconnoiter events. Avoid using superlatives like “best” when describing any CMS-regulated product per the Medicare Marketing Guidelines. Let attendees ask the questions and let your knowledge lead them to a later sale.

Agents can call (800) 997 3107 or click here to download a free checklist we’ve put together for Secret shopper-proofing your presentations.

7 reasons to make The Agent’s Advantage your go-to resource

The Agent’s Advantage, RB Insurance Group’s official blog, is updated almost daily for you to read on your computer, phone or tablet between appointments or as you get Ready to Sell for AEP. Here are seven reasons why you should make it your first stop for senior insurance sales news and special promotions.

1. Don’t sweat AEP. The Agent’s Advantage is your go-to for carrier-specific information and instructions during the busiest time of the year for senior insurance advisors. Learn more about our Medicare Sales Engine, a powerfully simple system you can use to manage your insurance business. Request your account today and start communicating with your Leads and clients like never before (By the way, its completely free for affiliated agents!).

2. AEP is not the only time for sales when you’ve got a portfolio of products. Learn how to take advantage of clients’ Special Election Periods to get the most out of your Medicare Advantage products, but don’t stop there. Appoint with best-selling Medicare Supplements, take on Hospital Indemnity or even add dental coverage to your portfolio to meet all your clients’ health needs and earn commissions year round.

3. Receive fewer emails. While some information belongs in your Inbox, such as your contract statuses and commission payments, others don’t need to take up such valuable space. We invite you to scroll more and sift less — you’ll get one weekly roundup of content each week when you subscribe to The Agent’s Advantage, and our easy to browse content may make you want to cancel some of your other subscriptions.

4. Expert sales advice from Senior Broker Tom O’Neil. Tom’s here to share wisdom he’s accrued during his 20-plus years in the industry. Writing weekly about best sales practices and simple ways to go the extra mile, Tom is also available to meet with RB Insurance-affiliated agents whenever they need help. If you’re in the area, make an in-person appointment at our Chandler office or simply call (800) 997 3107 to speak with him, one-to-one, on the phone. Email him here.

5.  Start a conversation with us. Like what you’re reading or want to learn more about something we’ve covered? Care to join our editorial staff and share your professional insight? Simply fill out our Contact form or Follow us on LinkedIn to let us know!

6. Find you authentic sales voice with Brandon Clay and learn what you need to sell to earn 6 figures. Every Tuesday, bestselling author and veteran sales coach Brandon Clay shows you how to approach sales with confidence, make the most out of marketing tools and build a portfolio that increases renewals and referrals to strengthen your business and grow your income. As you serve, you deserve!

7. Look no further than The Agent’s Advantage for regulatory news. We pay close attention to CMS, HHS and even Capitol Hill to help you navigate regulatory changes and announcements. Count on us for easy to digest Medicare, Medicaid and Affordable Care Act news that speaks directly to you as an agent.

Subscribing is easy — just click here.

How to build a compliant MA Agent website that works (Part 2)

Here’s my follow-up on tips how to compliantly build your own Agent or agency website. In this article I will be discussing required disclaimers for generic Medicare Marketing sites. Click here to view the CMS memo on this topic.

Required Disclaimers For Generic Agent/Agency Websites:

Agent's Advantage Blog
1. “Medicare has neither endorsed nor reviewed this information.” (See section 50.13 – Disclaimer When Using Third-Party Materials)

2. “Not connected or affiliated with any United States Government or State agency.” (This is also required by some states)

3.  “Calling this number will direct you to a licensed Agent/Broker.” (Include this if your site has a contact number that directs potential clients to you or a sales team.)

These three disclaimers will satisfy passive Agent/agency websites intended for Medicare beneficiaries that are generic and do not mention specific plan names, benefits, premiums or marketing materials and do not collect any beneficiary’s information. You can read the Medicare Marketing Guidelines here — many of these disclaimers are included within that document.

Disclaimers for Sites Collecting Information for Lead Generation:

If you choose to collect potential clients’ information on your website, also ensure you include the following disclaimers for your form submissions:

1. “By submitting this form and providing this information, you agree that an authorized representative or licensed insurance agent may contact you by phone, e-mail or mail to answer your questions and provide additional information about Medicare Advantage, Part D or Medicare Supplement Insurance plans.”

2. “This is a solicitation for insurance.”

This is by no means intended to be a complete list. In fact, there are many do’s and don’ts for the content of your website in addition to just the disclaimers listed above. You can view Aetna’s recommended do’s and don’ts by clicking here.  If you utilize your website for Lead generation or advertising your agency, the disclaimers and do’s and don’ts above will address many of the concerns CMS cited in their memo to Plan Sponsors.

But what If I want to list my contracted Plan Sponsors on my site and Compare Benefits?

Be prepared to submit your site for compliance review to each plan sponsor your list on your site. You must receive approval from each carrier for use of their name, logo and plan materials on your site. Your plan sponsor may also requires your site to be submitted to CMS for official review and approval. Speak with your plan sponsor’s marketing or compliance department for specific guidance on the use and publishing of their plan materials.

Build an attitude of confidence through compliance with your plan sponsors, your clients and yourself. You’ll be so happy you did when your site comes across the desk of a Plan Sponsor’s Compliance Officer, as new regulations now require CMS to audit plan sponsors and their contracted downline entities for compliance every other year.

Interested in learning more? Email me or call (800) 997 3107 to start a conversation about disclaimer and marketing guidance for sites listing and comparing plans and benefits.

How to build a compliant Medicare marketing website that works (Part 1)

Whether you are building your own Agent site or running a massive network of Lead generation sites, everyone who mentions Medicare-regulated products or carriers on their site must adhere to the 2015 Medicare Marketing Guidelines as well as rules or requirements published by the carriers you choose to represent on your site. CMS recently distributed a memo to MA and Part D Plan Sponsors on Compliant websites, which you can view by clicking here.

Take Note: This memo only applies to websites marketing Medicare Advantage, Part D or other Medicare regulated plans. If you only advertise Medicare Supplement plans or other non-regulated products, you are not required to adhere to the MMGs. However, we recommend including the disclaimers mentioned below in the footer of your site if you discuss any Medicare-related products.

Agent websites are subject to the 2015 Medicare Marketing Guidelines. Contact us with your compliance questions as you increase your online presence as part of a solid marketing strategy.

Agent's Advantage Blog

Taken as more than a gentle reminder, the majority of our carrier partners offering Medicare-regulated products have released agent notices via email to Agents and Agencies requesting review of their websites exhibiting logos, their brand name or product names to ensure compliance with this recent CMS memo. If you’re worried that you missed one of these notices in your inbox, call RB Insurance at (800) 997 3107 or email Rob Bever, our Director of Sales, Training and Compliance, and we will forward any communication we’ve received from your contracted carriers on this subject to you.

Here are a just few tips to follow when designing your Medicare marketing website to ensure it is compliant. Check back later in the week for a list of Do’s and Don’ts for your compliant Medicare marketing website.

Section 50 of the Medicare Marketing Guidelines lists required disclaimers for plan sponsors, but what do you have to pay attention to as an Agent? The tough answer is: All of it.

Disclaimers in the Medicare Marketing Guidelines apply both to plan sponsors and their contracted third parties and/or entities.

The advice offered below is intended for generic Agent/Agency websites:

What is a generic site? A generic Medicare marketing website means you market yourself and your services on your site. If you wish to avoid potential compliance violations, don’t mention or list specific plan sponsors or plan details on your site. If you are just launching a new site, it’s always safer to host a generic Medicare marketing site.  The moment you mention a specific plan sponsor name, plan or benefit, your site is no longer considered generic and you must submit it to each carrier you mention/list of your site for approval.

Needless to say, the more detailed your site is — particularly if you include information on specific plans, benefits, plan premiums, providers networks or formularies — the more compliance challenges you will face.

 If you have specific questions about your existing website or building a new compliant site, give us a call at (800) 997 3107 or drop us a line on our Contact page. We can answer your compliance questions and help you build a productive, compliant agent website together.

Read Part Two of this series here.