From February through early June each year, the Centers for Medicare and Medicaid Services (CMS) conducts “secret shopper” tests of Medicare plan call centers. These evaluations ensure that Medicare Advantage and Medicare Prescription Drug Benefit Plans provide effective communication for all, regardless of language preference.
Ensuring fast access to on-demand professional medical interpreters improves equity, quality of care, and efficiencies. It also maximizes reimbursements, as plans that secure at least 4 Stars receive a 5% bonus from CMS. In 2024, this equated to approximately $11.8 billion in Medicare Advantage (MA) quality bonus payments
The CMS Accuracy & Accessibility Study
A critical component of the Star Rating system is the CMS Accuracy & Accessibility Study. This study evaluates the “prospective beneficiary call centers” of Medicare plans to confirm they meet essential standards. These include:
- The availability of interpreters for Limited English Proficient (LEP) callers,
- TTY functionality for Deaf and Hard of Hearing individuals, and
- The accuracy of plan information provided by customer service representatives.
Ensuring fast access to on-demand professional medical interpreters improves equity, quality of care, and efficiencies. It also maximizes reimbursements, as plans that secure at least 4 Stars receive a 5% bonus from CMS. In 2024, this equated to approximately $11.8 billion in Medicare Advantage (MA) quality bonus payments, according to Kaiser Family Foundation (KFF) Research.
Star Ratings and the Accuracy & Accessibility Study
CMS assigns Star Ratings based on several factors, including the results of the Accessibility portion of the Accuracy & Accessibility Study. As part of the study, CMS places calls to assess how well Medicare Part C & D prospective beneficiary call centers assist callers with LEP, measuring both interpreter availability and the accuracy of the information provided.
For 2025, CMS will test call centers in the following languages: Spanish, Cantonese, Mandarin, Vietnamese, French, and Tagalog.
Is Your Call Center Prepared?
LanguageLine is dedicated to helping our clients achieve 5 Stars. We understand the critical role these test calls play in securing additional funding, effectively marketing your plans, and delivering an outstanding experience for your members and prospective beneficiaries.
We’ve helped many of the largest and most successful Medicare plans achieve success in the CMS Call Center Monitoring Study by partnering to execute a very strategic set of steps. This method has worked well for our clients who take advantage of this collaborative and unique approach. In fact, LanguageLine supports over 80% of 5 Star Plans.
With LanguageLine’s proven “5-Step Methodology for 5-Star Success,” your organization can achieve top-tier performance, whether you’re assisting a CMS test caller or a prospective beneficiary. Our comprehensive approach includes:
1. A dedicated line for seamless call management
2. A customized IVR call tree
3. Targeted training for your call center agents
4. Specialized CMS-specific interpreter training
5. Regular bi-weekly check-ins with your LanguageLine Account Executive
Download our latest eBook to discover the impact of these test calls on your Medicare plan, gain practical tips for success, and see how LanguageLine can help your plan secure a 5-Star rating in this critical study.