Top 5 Medicare Compliance Issues

Jun 17, 2016 |

Sayaka Page

Sayaka Page

AGA Compliance Officer

The sales and marketing support provided by an FMO has so much value for independent Medicare agents. A good FMO will help you improve and stay competitive. A great FMO positions you for success.

Applied General Agency is one of those FMOs. We make every effort to continually assist our agents in the educational process and keep them on their toes when it comes to compliance.

Our internal compliance team works tirelessly to ensure our agents:

  • Always understand the evolving CMS guidelines.
  • Know all their education resources.
  • Have an abundance of compliance training available at their fingertips.
  • Come to us when they need assistance or guidance.
  • Undergo corrective actions if a compliance violation were to occur.

We want to guarantee that our agents have the necessary tools to sell effectively, and we also want to ensure our agents are protected. To help safeguard the selling process, see these top compliance mistakes we’ve come across in the field.

Top 5 Medicare Compliance Mistakes

1. Misunderstanding carrier guidelines.

There are Centers for Medicare & Medicaid Services (CMS) rules, and then there are carrier rules. Some carriers even mandate stricter rules than CMS, making it vital for you understand the different guidelines and protocols set forth by each carrier.

AGA helps interpret the rules. We break down the sometimes convoluted guidelines into easy-to-follow messages. We deliver external marketing guidelines and information on a monthly basis so you’ll never have to worry about having to look for essential information.

2. Giving misleading claims.

You should never mislead your client. Often times, misleading claims stem from not fully understanding both your product offering, and the required selling and marketing practices.

AGA promotes safe selling and marketing practices at all times. We make it as easy as possible for agents to learn these by providing every opportunity to, not only learn the necessary information, but to practice it. Tests and quizzes on CMS and carrier guidelines (like AHIP) are administered. If, for whatever reason, you don’t pass, we can provide assistance to get the marks you need.

We further prepare our agents with comprehensive practice in compliance by way of our weekly training sessions (available as online webinars afterwards). We also offer training tools that are based on our regional manager’s actual sales experience in the field, illustrating real-life scenarios with corresponding proven best business practices.

3. Non-compliant marketing materials.

Online and print marketing guidelines have become more detailed over the past two years, and continue to evolve. All agent websites and printed materials must adhere to CMS guidelines; however, there are always a few agents who are non-compliant in some way.

At AGA, we provide CMS-approved website templates and personalized print materials for you, and make sure all your marketing is approved by the carrier.

4. Bad client communication.

You have to communicate effectively with your client. These are their health services, and their satisfaction is the key to your success as an agent. One of the main things we can recommend is ensuring your clients maintain their provider of choice. Always stay updated on recent primary care provider (PCP) lists (available on medicare.gov and from the carrier) and incorporate the most up-to-date information in your verification process. That way, you can let your client know if they’ll get to keep their PCP if they want to change plans.

5. Fearing corrective actions.

If any CMS rules are broken, a corrective action must be administered. We know that sounds scary, but it really isn’t—a corrective action just ensures you’ve learned from your mistake. A compliance issue arises when an agent doesn’t complete or rebels against their corrective action.

Some agents do this out of fear. It’s AGA’s goal to remove that fear and get you back on track. We take compliance seriously by educating our agents. It’s our job, along with the carrier, to coach and counsel any agent if a complaint comes through. Even if the agent is not at fault, the agent must be reminded of the proper sales or marketing practices by way of a corrective action. With a corrective action, our goal is to ensure all misunderstandings are cleared up.

AGA doesn’t just teach agents how to sell and market Medicare insurance. We teach how to do right and how to do it well. The rest it up to you. You could think of your career as selling Medicare insurance like school. If you do your homework and get to class on time, you graduate. However, if you break the rules, you receive a detention. As long as that detention is served, you can move on and continue learning.
When it comes to staying compliant as a Medicare sales agent, know that, whatever turn your career takes, AGA will have your back.

About Sayaka Page

I’ve been with AGA for four years. As the go-to person on compliance, it’s my duty to ensure our agents know how to correctly market and sell Medicare per CMS and carrier guidelines. We work day and night to ensure AGA independent agents have a robust level of sales, compliance, and event support as a foundation to grow from and achieve success with.


Our agents tell us we provide an unparalleled level of compliance, sales and event support. Learn more about the AGA advantage.

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Jun 17, 2016 | | 0 comments

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