Conversely AI

Navigate the Proposed CMS Rules For PY2024 With Conversational AI

2024 CMS proposed marketing rules

The Centers for Medicare and Medicaid Services (CMS) released proposed rules that could affect the practices your agents can sell Medicare products going forward in contact centers. We highlighted some of the areas where the deployment of an insurance-specific conversational AI tool can help you stay ahead of the game.

1. Lack of Oversight into Agent Behavior

CMS is concerned that Medicare Advantage organizations and Part D sponsors are being reactive instead of proactive in addressing inappropriate agent and broker behavior.  They are advising an oversight plan be deployed to identify behaviors that are not compliant with CMS.

Conversely AI’s tool will offer confidence that the right process is being followed by analyzing and providing visibility into 100% of sales enrollment calls. Automatically tag key insights, phrases, and required statements for immediate scoring and corrective action through a closed-loop management process.  We can even customize an oversight plan specific to your compliance program.

2. Finding an Applicable Plan for the Enrollee

CMS has listened to hundreds of marketing & enrollment calls and found that 80% of the time agents and brokers failed to ask pertinent questions to help a beneficiary enroll in a plan that best meets their individual needs.

Conversely AI can determine if a proper assessment is conducted ahead of enrollment.  In addition to understanding if the proper probing questions are being asked, we can analyze the customer responses and inputs to determine if the plan being discussed and sold fits the customer’s situation.

3. Ensuring Adherence to a Pre-Enrollment Checklist (PECL)

There are many references throughout the 2024 proposed rule to a PECL.  Enrollees need to understand the effect enrolling in a new plan would have on their existing coverage, along with a list of requirements and disclaimers that must be read before beginning an enrollment

Our AI classification models automatically capture moments in which the agent discusses the elements of the pre-enrollment checklist (PECL).  We’ve built our conversational AI specifically for Medicare (150+ intents for just MA enrollments!), so our tool understands the nuances of what needs to be said and when.  For example, if the tool detects the correct SOA was stated, but a plan had been discussed, a corrective action task is still created.  Many times there are multiple conversations that take place with a customer before the call in which the enrollment takes place.  Our tool can thread all of these calls together in order to give a comprehensive score for the entire sales experience. 

Interested in learning more about how a Medicare-specific AI tool can get you ready for any changes in CMS rules? Contact us at [email protected]

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