Navigating the Dramatic Changes in the Medicare Landscape: How SalesRiver Empowers Carriers to Stay Compliant

The Medicare landscape is evolving at an unprecedented pace. The Centers for Medicare & Medicaid Services (CMS) has consistently introduced regulations to ensure that Medicare Advantage (MA) plans, Part D sponsors, and all associated agents, brokers, and third-party marketing organizations (TPMOs) operate transparently and ethically. The latest CMS update, released last Friday (June 28, 2024), is a big change that carriers and sponsors will have to adjust processes to accommodate before October 15th of this year.

The Recent CMS Update: A Closer Look

Last year, CMS required MA Plans to oversee their agents, brokers, and TPMOs. While the initial mandate laid the groundwork for accountability, it lacked specifics on reporting major infractions. The recent release changes this narrative entirely. CMS now mandates that MA Plans and Part D Sponsors establish a robust mechanism to track all interactions and submit monthly reports detailing any improper conversations, misleading advertising, fraudulent enrollments, credentialing issues, and more.

This new requirement means that carriers and FMOs must not only enhance their technological capabilities to oversee these interactions but also take actionable steps to report infractions promptly. The implications are profound—carriers are now held directly liable for monitoring and acting on all agent, broker, and TPMO infractions.

The Impact on the Industry

These changes underscore a dramatic shift in the Medicare landscape. Carriers must now adopt more sophisticated technologies to ensure compliance and protect beneficiaries. The need for precise, real-time oversight has never been more critical. Failure to comply can lead to significant penalties and damage to reputation.

How SalesRiver Can Help

At SalesRiver, we understand the challenges that carriers face in this new regulatory environment. Our Integrated Growth Platform (IGP) is designed to meet these challenges head-on. Here’s how:

Intuitive AI for Compliance: Our AI is specifically trained to understand and navigate Medicare sales. It transcribes and analyzes all conversations, identifying potential infractions with pinpoint accuracy. This allows carrier leadership to take immediate, informed action.
Actionable Insights: Our platform provides detailed, actionable insights derived from real-time data analytics. Carrier partners can see exactly where issues arise and develop targeted strategies to address them.
Comprehensive Reporting: SalesRiver’s robust reporting tools ensure that all interactions are documented and any infractions are reported in compliance with CMS’s new requirements. This makes monthly reporting to CMS straightforward and stress-free.
Enhanced Oversight with "Teams": One of SalesRiver's standout features is our "Teams" system. This tool allows Carriers and FMOs to build specific teams within their hierarchy. With an infinite hierarchy tool, Carriers can create as many levels and teams as needed, tracking individual agents, FMOs, downline agencies, or independent agents at a glance. This capability enables Carriers to assign specific marketing channels to these teams and provides unparalleled visibility into each team's performance. By leveraging "Teams," Carriers can ensure that all activities are compliant and any potential issues are quickly identified and addressed.
Workflow Automation: SalesRiver can enhance workflows to include checks for credentialing issues, ensure marketing materials meet CMS guidelines, and verify that all telephonic enrollments and sales calls are properly recorded.
Customer Relationship Management (CRM): Your CRM features can be adapted to ensure all necessary documentation, such as scope of appointment and permission to contact, is correctly stored and easily accessible.

Embracing the Future

The recent CMS update is a clear indicator of the direction the Medicare industry is heading. Enhanced oversight and accountability are the new norms, and carriers must adapt quickly. At SalesRiver, we are committed to supporting our partners through these changes, providing the tools and insights needed to stay compliant and protect beneficiaries.

We invite industry thought leaders to share their insights on these developments and explore how innovative technologies like SalesRiver can assist in navigating this complex regulatory landscape. Together, we can ensure a future where Medicare services are delivered with integrity and transparency.

If you'd like to speak to our team, feel free to reach out here.