Who Keeps Track of Your Compliance?
All Medicare agents must follow the rules and regulations defined by CMS standards. They also need to follow the requirements for licensure in the states they sell in, and must meet the standards for appointment and certification by each carrier they represent.
Not only do agents need to meet those requirements to be ready to sell, but they must conduct business according to CMS standards. CMS requires Medicare Advantage and Prescription Drug Plan carriers to oversee downstream entities. The carriers are responsible for making sure agents abide by all state and federal laws, regulations and requirements. You must oversee the conduct of your agency for compliance, whether your business employees are non-agents, agents, or contractors.
How to Monitor Your Agents
You are responsible for the compliance of the agents contracted under you. First, you must become familiar with all applicable regulations. A dedicated compliance officer for your agency can assist with keeping track of the requirements and monitoring your downline agents.
Agent oversight on your part will include ensuring that your agents or brokers are properly licensed and appointed, per individual state requirements. Make sure that all marketing and communication materials are compliant and properly approved by CMS as required. Check that agents are not charging Medicare beneficiaries marketing fees.
Ensure that your agents are conducting sales presentations appropriately, with all necessary documentation. Check that your agents are completing Scope of Appointment forms for all marketing appointments.
Give Your Agents Compliance Tools
As the one responsible for the compliance of agents contracted under you, you can relieve some of the pressure by training them properly in the first place.
Provide training and coaching on CMS and carrier requirements for agents, including but not limited to:
- contact rules;
- compliant and thorough sales presentations;
- avoiding member complaints;
- sales and educational events;
- identification of proper enrollment periods;
- privacy/security; and
- compliant enrollment methods.
Everything from lead generation to submitting the application has to be done compliantly. To give helpful agent oversight, ask for feedback from your agents. If they would benefit from more in-person trainings or step-by-step walkthroughs of different processes, do your best to provide that.
Effective resources will help you and your contracted agents to become a reputable sales team with consistent methods, which will help your Medicare clients to trust your approach and respect your business. In that way, putting (required) energy into agent compliance will help your brand and your reputation.
