PFFS Enrollement - Face to Face ANSWERED

[GreenSky]

Just returned from Vegas a little poorer financially, but a little richer in knowledge.

Had a conversation with the trainer for Today's Options. I asked him if presentations and enrollments had to be done in person. His answer was that CMS did not require this. He basically told me that "CMS may not require a face to face." This question is specifically covered as part of his seminar training for agents.

He does not know if online enrollment will still be available but will let me know when he finds out.

I know that other carriers say we must do this in person but this must be a carrier requirement, not CMS.

So the bottom line is "I'm still in business!"

Rick

 

[J.R.]

Just returned from Vegas a little poorer financially, but a little richer in knowledge.

Had a conversation with the trainer for Today's Options. I asked him if presentations and enrollments had to be done in person. His answer was that CMS did not require this. He basically told me that "CMS may not require a face to face." This question is specifically covered as part of his seminar training for agents.

He does not know if online enrollment will still be available but will let me know when he finds out.

I know that other carriers say we must do this in person but this must be a carrier requirement, not CMS.


So the bottom line is "I'm still in business!"

Rick

How was the Ranch????

 

[craig_ritter]

Just returned from Vegas a little poorer financially, but a little richer in knowledge.

Had a conversation with the trainer for Today's Options. I asked him if presentations and enrollments had to be done in person. His answer was that CMS did not require this. He basically told me that "CMS may not require a face to face." This question is specifically covered as part of his seminar training for agents.

He does not know if online enrollment will still be available but will let me know when he finds out.

I know that other carriers say we must do this in person but this must be a carrier requirement, not CMS.

So the bottom line is "I'm still in business!"

Rick

Rick: I agree that there is no CMS mandate for a F2F or personally witnessed sig. FWIW!

Craig

 

[policy doctor]

I can't believe I missed this entire thread. Now I see why some were so upset with me. SORRY

 

[retread]

I think some people have been misunderstood by the enquirer not making clear their question. A face-to-face presentation of RE-CERTIFICATION is required for at least some MA carriers. I don't propose to speak for them all, but I do know that Today's Options was one of them. Only two states had that requirement, and they were Kansas and Oregon. They were singled out by CMS as having some issues. All other states could re-certify online.
When speaking of ENROLLMENTS, MA plans CANNOT be taken over the telephone. You are to call for an appointment, because you CANNOT show up uninvited. As far as the "face-to-face" is concerned, there is nothing wrong with taking an enrollment over the phone for a Medigap policy, but it is forbidden with MA plans. NO OUTBOUND ENROLLMENTS, i.e. no telemarketing for the purpose of enrollment, only appointments. Read the regulations for yourself:

Medicare Marketing Guidelines for MAs, ch 2, p. 136. Look here: http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/FinalMarketingGuidelines.pdf

INBOUND enrollments can be set up by IVR, and ONLINE enrollments via the web, but are strictly regulated. All scripts must be submitted for review by CMS.

This issue has been stressed at my recertification classes for both HMO/PPO and PFFS carriers. This is a big thing with CMS! Apparently, either not enough of you guys have paid attention in class or for some reason did not get the word. Both door-to-door and telemarketing sales have come into close scrutiny. Listen up, or you are gonna get your license spanked! It is very simple: No door-to-door (unexpected visits) or pushy telephone calls (outbound enrollment attempts). Call, using FTC guidelines (scrub DNC list, during acceptable hours -8a.m. to 9p.m.) and offer your services. Additionally, there is a laundry list of things you must say, and things you can't say. Read up on it.

 

[James]

Inbound Call Rules:

Plans are not permitted to:

• Conduct outbound telephone enrollment.

• Transfer outbound calls to inbound lines for telephonic enrollment.

•​

​

Market or enroll other lines of business as part of the telephonic enrollment
script.

• Request or collect credit card numbers or bank account information for any​

purpose during the telephonic enrollment call.

​

​

Outbound Call Rules:​

To this end, the MMA allows plans to conduct outbound telemarketing within the scope
of the following guidelines.

• Organizations may conduct outbound telemarketing activities for health related
products to the extent permitted to do so under the HIPAA Privacy Rule.

• Organizations may not conduct outbound telemarketing activities for non-health
related items unless beneficiaries have provided prior written authorization.
This rule is intended to protect each beneficiary’s privacy rights under HIPAA.
In order to further protect the privacy of potential plan enrollees and to ensure that
outbound telemarketing activities present clear, concise, and accurate information that
enables potential plan enrollees to make an informed choice, all telemarketing activities
must adhere to the Federal Trade Commissions Requirements for Sellers and
Telemarketers, the Federal Communications Commission and applicable state law.
In addition, organizations must:

• Comply with the National-Do-Not-Call Registry,

•​

​

Honor “do not call again” requests, and​

•​

​

Abide by Federal and State calling hours.
In addition, because of the complex nature of offerings, enrollment by outbound
telemarketers is not allowed. Rather, outbound telemarketing may be used solely to​

solicit requests for pre-enrollment information,

​

​

If these rules are followed I would imagine most plans be difficult to do over the telephone.​

​

 

[Slick]

The Coventry re-cert made it very clear that you must be face to face for telephonic and online enrollment. You may take a paper app. and fax it in later that day.

 

[retread]

Thank you, James, and also Slick.... you restore some faith in the credibility of my fellow forum members. At least some are up on the rules.

What bothers me is Greensky's report that a Today's Option "trainer" could not answer his question. It is absolutely clear in Today's Option compliance manual. All company representatives should know those rules. Additionally, any agent contracted with them should have access to the compliance manual. (I am not going to copy it here due to privacy policy)

 

[GreenSky]

Thank you, James, and also Slick.... you restore some faith in the credibility of my fellow forum members. At least some are up on the rules.

What bothers me is Greensky's report that a Today's Option "trainer" could not answer his question. It is absolutely clear in Today's Option compliance manual. All company representatives should know those rules. Additionally, any agent contracted with them should have access to the compliance manual. (I am not going to copy it here due to privacy policy)

Please re-read my post. The trainer was absolutely certain (and even documentation proves him correct) that face to face is NOT required by CMS. Carriers may impose this just as Coventry has, but it is not a CMS requirement.

He was not certain how we could move forward on electronic enrollments.

I don't know why my report bother you and I really don't understand your comment about compliance, etc. The question on enrolling on-line has nothing to do with compliance.

There is another thread that discusses Today's Options at nauseum. I suggest you search for it and read it. I believe your concerns will be answered.

Rick

 

[James]

Please re-read my post. The trainer was absolutely certain (and even documentation proves him correct) that face to face is NOT required by CMS. Carriers may impose this just as Coventry has, but it is not a CMS requirement.

He was not certain how we could move forward on electronic enrollments.

I don't know why my report bother you and I really don't understand your comment about compliance, etc. The question on enrolling on-line has nothing to do with compliance.

There is another thread that discusses Today's Options at nauseum. I suggest you search for it and read it. I believe your concerns will be answered.

Rick

Let me ask this, are you saying that I can do enrollment for MA's with outgoing calls or calling clients?