End Call If a Medicare User Refuses Recording: Officials to Agents

CMS Answers

Here are some of the topics CMS officials discuss in the new TPMO guidance.

The TMPO definition: “The definition of TPMO includes all organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment related functions as a part of the chain of enrollment,” officials say. “TPMOs may be a first-tier, downstream or related entity.”

The acronym for “first-tier, downstream or related entity” is FDR.

Officials note that CMS is treating all agents and brokers the same.

“Smaller agents and brokers are not exempt from any requirement based on size,” officials say. “CMS does not believe it is appropriate, or even possible, for the purpose of applying regulatory requirements, to distinguish between independent agents who work for a ‘large call center’ versus those agents who do not, as many of these ‘independent’ agents are associated with an FMO [field marketing organization], which may employ hundreds or thousands of agents. And those FMOs may have contracts with both clearinghouses/lead generators as well as independent agents.”

Which calls? A plan now must ensure that all TPMO calls with enrollees, “even calls that are outside the scope of the chain of enrollment,” are recorded.

The recording requirement applies both to inbound and outbound calls.

Storage: A plan and the TPMO may not have to worry about actually storing the recordings of calls about administrative matters, such as updating ID cards. “If, however, such a call becomes a sales call at any point (e.g., if the beneficiary begins asking about products), then the recording of the call would need to be retained,” officials say.

When a call recording must be stored, it must be retained for at least 10 years.

Call recording and retention responsibility: “CMS holds plans responsible for making sure that the recordings of calls between TPMOs and beneficiaries are recorded and that the recordings are maintained,” officials say. “Plans and TPMOs should arrange for recording and storage of the recordings.”

Some agents and brokers have told CMS that they are not set up to record calls with consumers.

CMS officials say the requirement to record telephonic enrollments has been in place for some time.

“If a TPMO engages in telephonic enrollment, they would have been required, under existing policy, to record calls with beneficiaries prior to the implementation of this regulatory requirement,” officials say. “As such, we would expect TPMOs to leverage their existing process for recording telephonic enrollments when recording all calls with beneficiaries.”

Smaller producers should ask the plans they represent for help with recording and maintaining calls, officials add.

Face-to-face meetings: Officials note that the new recording requirements do not apply to in-person interactions.

Broker Reactions

Companies like Senior Market Sales and Integrity Marketing Group are now offering call recording help to affiliated agents.

Chapter, a web broker that says it offers consumers help with buying all available Medicare plans, through the AskChapter.org website, is questioning whether CMS is requiring TPMOs to give consumers enough information, and whether some TPMOs make it clear enough that they offer only a few high-commission plans.

“Misleading advertisements often promise a lot — even home-delivered meals — for little to no cost, while leaving out key details about the plan, such as the price of co-pays and whether one’s doctors will still be in-network,” Chapter says. “Brokers often use these tactics to push plans that are too expensive and do not cover enough health care costs.”

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