Preparing for CMS Test Call Season
Integrate Language Access Boost Agent Productivity Maximize Your Star Rating
Are your customer service representatives prepared to assist limited English proficient (LEP) callers properly? As the Centers for Medicare & Medicaid Services (CMS) starts conducting test calls, partner with PGLS to maximize your CMS Star Rating.
About CMS
The Centers for Medicare & Medicaid Services (CMS) is a federal agency responsible for administering the Medicare program. CMS also collaborates with state governments to manage Medicaid, the Children’s Health Insurance Program (CHIP), and health insurance portability standards.
CMS Star Ratings
CMS rates Medicare plans on a scale from 1 to 5 stars. This star rating system was established by CMS to evaluate the quality of the plans, and help seniors select the most suitable option. The ratings also play a crucial role in CMS’s decisions on whether plans can continue to bill Medicare for their services.
Plans that achieve a rating of 4 stars or higher receive a 5% bonus from CMS. In 2023, this amounted to about $12.8 billion in quality bonus payments for Medicare Advantage (MA) plans. However, average ratings have declined in recent years due to the lingering effects of the COVID-19 pandemic and a new methodology for calculating ratings.
CMS Accuracy and Accessibility Study
Every fall, the CMS publishes its annual Accuracy and Accessibility Study, which measures performance in assisting limited English proficient (LEP) callers. The result of this annual study plays a big role in determining the star rating a plan receives. This is why it is crucial to partner with a Language Service Provider like PGLS to ensure your customer service representatives are equipped with the resources they need to assist your LEP patient population.
CMS Test Calls
CMS measures performance by conducting test calls. Test calls are made by “secret shoppers” who are limited English proficient (LEP) individuals posing as patients or family members of patients seeking information about their insurance plan benefits and coverage.
Here’s how a test call is usually conducted:
- STEP 1: The CMS test caller starts a call. They should be able to talk to a live customer service representative within 10 minutes, including the time spent on hold.
- STEP 2: After the CMS test caller has an interpreter on the line and has asked an introductory question, they should be able to start asking the first of 3 survey questions within 8 minutes.
- STEP 3: The last part of the test includes three survey questions asked by the test caller. Each question should be answered within 7 minutes. The questions come from CMS publications like the 2024 edition of Medicare and You and information specific to the insurance plan.
During the testing period (conducted annually from February through June), any call related to health insurance may be a secret shopper call. As an insurance provider, it is crucial to prepare your customer service team for these calls, and to make sure they have quick and easy access to the appropriate language resources.
Assessment Criteria
The test calls conducted by CMS evaluate a number of criteria. Generally, the test calls evaluate how easily beneficiaries can access the information they need, the length of hold times, and the easy of navigating automated systems. With LEP patients, CMS measures both the availability and accuracy of the interpreter provided by the customer service representative in the following languages: Spanish, Mandarin, Cantonese, French, Vietnamese and Tagalog.
Preparing Your Customer Service Team
Your customer service team needs to be prepared when the next test call season comes around. They need to know what metrics CMS evaluates, and more importantly, they need to know how to quickly access the appropriate language resources to assist your limited English proficient (LEP) patients.
- Ensure your customer service team are aware when CMS test call season takes place so they can staff appropriately
- Educate your customer service team on the CMS assessment criteria so they can prepare accordingly
- Make sure your customer service team know how to quickly dial in a professional phone or video interpreter
- Educate your customer service team on how to interact with a professional interpreter and conduct test calls of your own
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PGLS can connect your customer service team to a qualified interpreter within seconds to ensure clear and accurate communication between your organization and your multilingual beneficiaries. Our phone interpreting solutions are easy to integrate, easy to access, and can be deployed across your organization in no time. As your health equity partner, PGLS can not only help facilitate real-time language access, we can help you maximize your CMS star rating, and help you achieve the highest possible CMS incentive funding.