How to Prepare for CMS Test Call Season

Call center agent

The Centers for Medicare and Medicaid Services (CMS) test call season is right around the corner, which means prospective beneficiary call centers are bracing themselves for the Accuracy & Accessibility Study.

The Accuracy & Accessibility Study is part of the CMS Star Ratings program and includes test calls that are made by CMS “secret shoppers” every year between February and June. The purpose of the test calls is 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, which an interpreter must interpret quickly and accurately.

While call center performance represents a small portion of an organization’s Star Rating, a lower rating can mean the loss of millions of dollars in reimbursements. Star Ratings are also a marker of plan quality and published on the Medicare Pathfinder (MP); if a plan receives a score of fewer than 3 stars for three years in a row, the plan is flagged with a low-performing icon. Medicare Advantage plans that receive a 5-star rating can enroll beneficiaries and market their products year-round.

Preparing for CMS test call season requires strategy, training, and a close-knit partnership with your organization’s language services partner, but the process doesn’t have to feel like a black box. Here’s how you can set your organization up for success.

Equip Your Agents for Success

It’s a stressful season, and you want your agents to feel at ease and confident that they’re armed with the knowledge and support they need to succeed.

  • Set expectations with agents. Clarify their roles, goals, and performance expectations so they know exactly what’s expected of them and how they can contribute during CMS test season.
  • Ensure that agents can quickly identify a CMS test call. Train teams to recognize the signs that a call is actually a test call—for example, overly scripted language or formulaic questions.
  • Collect and share past questions. Because many questions are recycled from one year to another, it can be helpful to collect questions asked during past test call seasons to help your teams make a quick ID. Pass these along to your language services provider as well.
  • Furnish agents with informational scripts. This can help them facilitate communication intended to educate and answer prospective beneficiary questions, even if an interpreter is not needed.
  • Ensure that agents know how to access help. Make sure that they understand how to quickly and efficiently loop an interpreter in and that they have ample support during calls.

Reinforce Your Call Center Operations

While agents play a critical role in answering CMS auditor questions and looping in an interpreter when needed, their success hinges on the processes you put in place in the call center.

  • Ensure that your organization is listed accurately on the Health Plan Management System (HPMS) list, which CMS uses to make test calls. Verify your toll-free beneficiary call center numbers, toll-free pharmacy help desk numbers, and current and prospective enrollee toll-free TTY numbers. Inaccurate phone numbers can cause you to receive poor results on the measures.
  • Periodically review your call center’s internal processes, policies, and training protocols to make sure they’re up-to-date and reflect best practices. This includes things like establishing a phone line dedicated to your CMS calls and implementing an internal monitoring program to verify that every call your agents handle—regardless of whether the beneficiary needs an interpreter—is up to par.
  • Staff up during test call season. Ensure that you are adequately staffing your call center during CMS-designated “usual business hours,” so your agents can answer test calls promptly.

Choose Your Language Services Provider Wisely

Whether you already have a partner in place or are evaluating potential partners, you should ensure that your language services provider is experienced with CMS call monitoring requirements.

  • Ensure that your language services provider takes test call season just as seriously as you do. Learn more about the organization’s approach to supporting health plan clients before, during, and after CMS test call season. Look for a partner who has a comprehensive year-round program focused around CMS that targets not just interpreters but also their call center.
  • Work with an organization that has a proven track record. A seasoned language services provider will not only be knowledgeable about CMS regulations, but will also staff interpreters who are familiar with CMS terms and test calls, able to correctly interpret and completely relay Medicare program information, and comfortable with protocols to ask for repetition or clarification to ensure accuracy.
  • Make sure your partner has the right resources in place. Ensure that your partner has ample interpreters in the six languages required by CMS—including Tagalog, which can be difficult to staff for—and who are familiar with the precise terminology the auditor will be listening for.
  • Evaluate the provider’s quality assurance (QA) processes, particularly around CMS calls. They should expect—and be willing—to take part in regular calibration sessions to review any calls that failed.
  • Use the CMS test call season to bolster your relationship with your language services provider. Your relationship should be a collaboration, one that doesn’t end when test call season does. Share your test call results with your partner, so they can better decide where to put more resources to help you perform at your best next year.

Above all, ensure that everyone—from your operations managers and your agents to your language services provider—understands the critical importance of the CMS test call season. The process is designed to advance health equity, improve quality, and help eliminate health care disparities—and it can also impact your organization’s bottom line. By taking steps to prepare your agents, call center, and language services provider, you can feel confident that you’re putting your best foot forward.

About the Author

Kristin Quinlan, CEO of Certified Languages International (CLI)Kristin Quinlan serves as CEO of Certified Languages International (CLI), a U.S.-based, on-demand interpreting company founded in 1996. Kristin joined the company in 1999, rising to CEO in 2006. With over 250 employees and thousands of professional interpreters, CLI is a full-service language company specializing in remote interpreting services over phone and video in 230+ languages, servicing 20,000–30,000 calls per day. Thousands of organizations across the country rely on CLI to help them communicate with a growing demographic of limited English proficient (LEP) speakers in every industry, including financial institutions, call centers, insurance companies, government agencies, court systems, schools, healthcare systems and medical clinics, pharmacies, utilities, telecommunications, technology, retail, and technology companies. Under Kristin’s leadership, CLI isn’t just a provider of interpreter services, but an advocate fighting for the greater good of comprehensive language access.

About Certified Languages International

Established in 1996, Certified Languages International (CLI) provides fast and easy 24/7 access to 2,500+ professional interpreters over phone and video in 230+ languages, servicing up to 30,000 calls per day. Interpreters with industry-specific knowledge are carefully selected and stringently vetted to ensure they can provide effective communication between parties who speak different languages, which can help build trust between businesses and their clients. In addition to remote interpreting services, CLI offers a virtual interpreter call center solution, document translation in 100+ languages, transcription (audio, video, and Braille), and assessments for bilingual proficiency and interpreter skills. The company’s exemplary language services are complemented by its commitment to collaborative partnerships with clients, high-touch support, and extraordinary customer service. CLI isn’t just a provider of interpreter services but also an advocate fighting for the greater good of comprehensive language access.

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