The Centers for Medicare & Medicaid Services (CMS) now defines Medicare Advantage agents and brokers as TPMOs (third-party marketing organizations).
Effective October 1, 2022, CMS has imposed new call recording and liability disclaimer requirements for TPMOs.
Among the new requirements coming into effect soon, agents and brokers will have to record all sales calls with beneficiaries completely, including the enrollment process. Recordings must be retained for 10 years in accordance with HIPAA and these requirements will apply to new and existing customers, as well as landlines and mobile lines.
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Why is this happening?
Whether a person is approaching 65 or has been on Medicare for years, there is no denying an onslaught of information they receive every day about Medicare, the plans they have access to, and the push to “act now.”
CMS’ purpose for including these new requirements is to get two things straightened out:
- The seniors targeted by these plans regularly receive information via mail, visit websites that provide “Medicare information,” and see commercials in media featuring big-name celebrities promoting Medicare Advantage options. But, when one of these interested consumers calls or fills out a form on a website to inquire about Medicare Advantage plans, they are not told whether they are getting direct help or are being referred to a third party.
- Consumers are not aware of the scope of options considered when making a Medicare plan recommendation because the terms and conditions are often unclear.
What does the new call recording requirement imposed by CMS entail?
Agents and brokers must record all sales calls with beneficiaries in their entirety, including the enrollment process. Recordings must be retained in a HIPAA-compliant manner for 10 years. This will apply to new and existing customers.
What is considered a sales call? Anything that falls within the “enrollment chain,” i.e., all calls from the time a customer is told about a Medicare Advantage plan to the end of the enrollment process in that plan. This includes those calls to prospective customers, scheduling appointments, compiling provider and drug lists, conducting educational meetings, and telephone enrollments. All of these calls must be recorded, whether they are landline or wireless, due to the new compliance requirement.
It should be noted that although Medicare Supplements are not included in the new call recording rules, if a Medicare Supplement is being sold in conjunction with a Prescription Drug Plan, the call must be recorded due to the Part D discussion.
But… What is HIPAA?
Clinics, hospitals, health insurance providers and their subcontractors rely heavily on unified communications and VoIP services to manage their patient information, interactions and communications.
When a patient needs to access their health records or a healthcare provider needs to reference or share personal health information, the transmission must be made over a secured channel to comply with HIPAA regulations.
HIPAA, which stands for the Health Insurance Portability and Accountability Act of 1996, was implemented in the U.S. healthcare system to improve its efficiency and effectiveness. It outlines the requirements and set of national standards that the Department of Health and Human Services (HHS) must enforce in electronic and telephonic healthcare transactions.
With technological advances in electronic communications and transactions, HIPAA helps protect the privacy of individuals and their health information.
What does a call recording system need to comply with HIPAA?
Under HIPAA, professionals must observe the law’s three rules governing privacy and security. These are as follows:
- Privacy Rule: ensures privacy by keeping information that could identify a patient protected.
- Security Rule: this rule governs how professionals keep electronic medical records secure.
- Breach Notification Rule: If a security or data breach occurs, this rule governs who an entity informs and how.
Therefore, call recording solutions used to meet the new requirement for those agents and brokers who come Medicare Advantage and ensure HIPAA compliance must obey the following requirements:
- The call recording solution must be fully secure and keep all conversations encrypted and encrypted on a secure server.
- The recording solution must have 10-year custody of and access to each recorded conversation from a secure portal.
- There must be an access restriction, being able to configure and monitor the access and privileges of the users through secure authentications.
The most complete solutions, such as Recordia, allow call recording through a SaaS service in the cloud that is totally secure and meets the highest security standards. Recordia allows:
- Capture and custody: record all interactions legally and adjust the custody period and the geographical location of the servers where the encrypted and secure captures are to be stored.
- Centralizes and manages recordings in a single program, all recordings and captures remain secure within Recordia.
- Ensures authenticity and transparency, thanks to the HASH fingerprint it is demonstrated that each interaction remains unaltered from end to end.
- It comprehensively controls access, limiting access to data; it configures access and permissions for Recordia users. Two-factor authentication (A2F) is required for access.
- Retrieve and share all interactions: the trace of interactions can be retrieved at any time in case of audit or query, or if their modification or deletion is required by users.
Are you a TPMO and need to record sales calls from a cell phone?
Many of these agents who will now be required to record their Medicare Advantage sales calls do not have the resources to be able to do so. As small businesses or even individual insurance brokers, having the software and infrastructure in place to record the calls and keep them securely stored becomes impossible.
In addition, these small companies find that the government did not impose the task of providing this type of support to large insurance companies and agencies.
For this reason, solutions such as Recordia Telephony System (RTS) allow these sales agents to operate worldwide by providing an international telephone network for mobile lines that allows them to call from anywhere. RTS works over the Internet, allowing TPMOs to record all calls within Recordia in a safe and secure environment without complex integrations or the need to switch carriers or PBXs.
Find out more about how Recordia can help you comply with the new call recording requirements imposed by CMS for Medicare Advantage agents and brokers by clicking here.