Keep Your AEP Momentum: Avoid These Common Compliance Mistakes

October 14, 2019

The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, is steadfast in its responsibility to protect beneficiaries from unscrupulous insurance practices. Compliance is a critical issue year round, but is vitally important during Medicare’s Annual Enrollment Period (AEP).

Agents juggle a vast amount of activity during AEP. Unintended actions can be a pathway to making compliance mistakes, which can slowdown or derail the AEP application process.

To ensure a smooth and efficient AEP, agents should familiarize themselves with these common areas where compliance mistakes can easily occur.

Scope of Appointments

CMS requires that beneficiaries sign Scope of Appointment (SoA) forms prior discussing Medicare Advantage or Part D Prescription drug plans with an agent. SoAs detail the exact topics beneficiaries want to discuss with an agent. It’s important to remember that EVERY appointment with a beneficiary requires an SoA, and SoAs must be kept on file for 10 years, even if the appointment doesn’t result in a sale.

Healthcare Providers

Before agents can help clients with a Medicare plan, they must know the physicians and specialists clients see for their healthcare services. Many beneficiaries are happy with their healthcare providers and don’t want to change. Compare their current providers with the providers in the plan’s network to ensure there isn’t a disruption in services.

Agents should take the time to review the enrollment data with their clients. If they find an error, they can fix it then rather than having the application returned.

Submitting Application to the Carrier in the Required 24-48-Hour Time Frame

Agents can get busy during AEP and put off submitting an application to a carrier until later. That can result in the application not being submitted in the required 24-48-hour time frame.

Agents should fax the application to the carrier as soon as the application has been completed with the beneficiary.

An agent’s primary responsibility is ensuring clients’ insurance needs are met. Agents are putting their clients front and center when they take the extra time to double check they haven’t committed these common compliance mistakes.

As always, we thank you for your support and cooperation. For questions or comments, please email us at Compliance@NSGACommunications.com or you may call the toll-free number listed below.

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