11 tips to stay compliant in selling Medicare Advantage

Calendar year 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F) was recently released, after public input. The result might be challenging for the industry.

Agents and brokers are now considered third-party marketing organizations, or TPMOs, which means they now are required to record all marketing calls with both clients and prospects where Medicare Advantage and Medicare Part D plans are discussed.

CMS also now requires a standardized disclaimer where appropriate:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area.

Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

Moreover, this CMS-required disclaimer must be prominently displayed on any landing page, website or email sent by a TPMO or their first-tier, downstream or related entity.

Additionally, when applicable, TPMOs must disclose to the Medicare beneficiary that their information will be provided to a licensed agent for future contact.

Many are asking, and rightly so, what exactly do we need to do differently?

Here are 11 tips to ensure your system keeps you in compliance with these new CMS marketing rules.

1. Make sure your system uses artificial intelligence-generated conversation guides for each prospect automatically. If the prospect needs to be informed of anything for compliance, that talking point should automatically be included in the conversation guide. Your system should track everything sent or said by either party. The same compliance statement should not be suggested if the prospect has already been informed.
2. The talking point for the required disclosure should stand out from the other conversation talking points by any or all of these approaches:

• All capital letters.
• Stand-out colors like red or yellow.
• Bold text.
• Italic text.

3. The system could show a green flag that lets the agent know that the wording of the disclosure has been changed in the last 10 days (to stay current with any future CMS changes) so the agent will know they need to read the new wording rather than rely on their memory of the required disclosure message.
4. When the sales representative begins discussing the next point, the system should automatically reload the AI-generated conversation guide so that the required compliance statement is then listed as “compliance statement given” in normal text (maybe with a check mark to indicate that the required compliance has been given). The agent sees a positive affirmation that the compliance statement has been delivered. This positive affirmation could appear in the conversation guide for subsequent calls so that agents will know that the compliance requirement has been met.
5. At the beginning of a call, there might not be enough information on the prospect to know if (or which) the compliance statement must be read to the prospect. For example: If the prospect’s age is discovered during the conversation, just entering their birthdate (or age) should trigger any required compliance statement to pop up in the screen and automatically be added to the regenerated conversation guide to make it “click simple” to know what to say and to document when it was said for compliance tracking.
6. At the end of each call, the system should generate an email to summarize the points discussed and include links to appropriate reference material. These AI-generated emails also should include the appropriate reference to (or complete compliance statement) to document that the prospect was informed appropriately.
7. A detailed record showing the date, exact time, and actual duration of the discussion of the compliance statement should be added automatically to a “story-so-far”-type record for that prospect.
8. This story-so-far-type record should be a call map showing the details of every call. If the agent is recording the call, their manager or anyone who wants to confirm the discussion of the required disclosure statement should be able to click on the entry in this story-so-far-type record to play the recording of the discussion (maybe even giving a 3D view of the discussion if the agent was recording the meeting with visual (like recorded Zoom calls) meeting recording tools.
9. It also should be easy for the system to generate reports with links to both the recorded calls and to the documented discussion of the compliance statement in this story-so-far-type record.
10. Reports also should highlight prospect meetings where the agent failed to make required compliance statements as a management/compliance tool and to guide the agent to make another contact so they can give the required disclosure.
11. The system reports also should validate that the compliance statement was made in all the applicable calls (with the exception of the agent mistakes that should have been documented and corrected in Point 10 above.)

Lloyd Lofton is the founder of Power Behind the Sales. He is the author of The Saleshero’s Guide To Handling Objections, voted 1 of the 11 Best New Presentation Books To Read in 2020 by BookAuthority. Lloyd may be contacted at [email protected].

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Lloyd Lofton is the founder of Power Behind the Sales. He is the author of The Saleshero’s Guide To Handling Objections, voted 1 of the 11 Best New Presentation Books To Read in 2020 by BookAuthority. Lloyd may be contacted at [email protected].