The Centers for Medicare and Medicaid Services (CMS) test call season is underway, with prospective beneficiary call centers receiving high-stakes calls from CMS “secret shoppers.”
Part of the CMS Star Ratings program, the Accuracy & Accessibility Study includes test calls designed to measure the accuracy of the information provided to a prospective beneficiary as well as the accessibility of interpreters in French, Spanish, Vietnamese, Cantonese, Mandarin, and Tagalog. The test callers ask a series of questions related to the plan’s policy; success depends, in part, on accuracy of the information provided and availability of interpreters.
Performance on these test calls impacts the organization’s Star Rating, which is a marker of plan quality published on the Medicare Pathfinder. A lower rating can mean the loss of millions of dollars in reimbursements.
With so much on the line, you shouldn’t leave your success on CMS test calls up to just any language services provider (LSP). Here’s what you should expect from an LSP—and the questions you should be asking to determine whether they have the right mix of knowledge, process, and experience to help you ace the secret shopper calls.
Select a provider who treats you as a partner
Choosing an interpreting provider is about building a relationship, and it’s no different when it comes to CMS call center monitoring. Test call season is stressful for everyone involved, so you want to ensure that your LSP is there to support your teams before, during, and after CMS test call season.
Partnership and communication go hand in hand. Your LSP should pass along relevant updates to you and be transparent about their internal protocols around CMS test calls. They should also be willing to provide feedback, performance reports, and status updates as often as you want, whether that be daily or weekly, to ensure that there are no surprises when it comes to test call performance. In addition, your LSP should give you contact information for their key personnel, so you can maintain open lines of communication at all times.
Ask your LSP:
- What level of support do you provide for your clients around CMS test call season? How do you collaborate to help them prepare their call center agents?
- What type of reporting do you provide on metrics such as language, average connection time, and total call duration? How frequently do you report out, and are these reports customizable for CMS calls?
- What’s your process for concerns with CMS calls?
Look for a partner who is committed to continual improvement
You want your LSP to take CMS test call season as seriously as you do, and that includes taking action throughout the year. Your partner should have a thorough planning process just for CMS season in place. Ideally, it should align with your own.
LSPs that handle a lot of test calls know that preparation is key. They should always be refining how they prepare and looking for ways to make sure your agents can quickly connect to an interpreter. Review the CMS-specific materials they provide to their interpreters, staff, and clients to ensure that the information is sound. Check to see if they cultivate contacts within CMS, conduct their own internal CMS test calls, and have a process to regularly reevaluate everything from QA to operations.
Ask your LSP:
- How and when do you start preparing for the CMS testing period?
- What systems do you have in place to identify and prioritize calls regulated by CMS?
- What’s your process to monitor interpreter availability, connection times, and accuracy of CMS calls?
- How do you keep up with changes to CMS star rating guidelines?
Look for a partner who prioritizes high-quality interpreters
An experienced LSP will not only be intimately familiar with CMS regulations, but also provide interpreters who are experienced with CMS terms and test calls. The better the interpreter is, the more time they invest in both performing self-assessments after each call and in preparation, including reviewing glossaries and questions from past years. Interpreters who are experienced in CMS test call season will rely on interpreter protocols, such as taking notes and having resources handy, and know when they should ask the test caller to repeat the question.
Ensure that your LSP has a thorough credentialing process for onboarding interpreters and a QA program to monitor interpreter performance. Their QA program should also involve evaluating quality indicators unique to CMS test calls.
Ask your LSP:
- How do you assess interpreter skill and language proficiency?
- What QA processes do you have in place to ensure that your interpreters are high-performing?
- How do you prepare your interpreters for CMS test season?
Preparing for the CMS Accuracy & Accessibility Study is a year-round endeavor, but you don’t have to go it alone. By creating a true partnership with your LSP—one that hinges on continual improvement, preparation, and high-quality interpreter services targeted to the test call process—you can set your organization up for success and help ensure that the star rating you receive reflects the quality of the care and services you provide your members.
Photo: Carol Yepes, getty Images
