Why CMS 5-Star Ratings Matter
For health insurance companies, a CMS 5-star rating is more than just a badge of honor—it’s a cornerstone of financial stability and consumer trust. This rating is critical for their financial viability and their customers’ loyalty. Get a quick peek into how Assertion’s CMS notification service can help obtain and retain this much sought after rating.
The Importance of a Five Star CMS Rating.
Today, American consumers meticulously compare plans before making decisions. Centers for Medicare and Medicaid Services (CMS) provides a uniform five-star rating for each plan offered by insurers, which makes it possible to compare across different insurance providers. With a high rating, insurance companies get:
- Increased Enrolment: Higher ratings draw more enrolment, thereby directly increasing profits.
- Financial Incentives: Plans with higher ratings receive additional bonuses and incentives from CMS.
- Reputation: A 5-star rating signals excellence in provision of service and quality, strengthening customer confidence and loyalty.
Financial Stakes
The US government spends a lot of money on elderly care through Medicare and Medicaid programs – up to $1.8 trillion is given every year to insurers as subsidy for healthcare expenses by enrolees. If an insurance company loses its 5-star rating, then it may lose millions of dollars’ worth of grants and business from consumers.
The Role of Customer Service in CMS Ratings
Customer service is a critical element of the final CMS scores. It’s part of the 40-point checklist used by CMS auditors when determining the rating of health plans. Poor service could result in loss of points – this is why insurers enforce strict quality of service rules on their customer care providers.
The Radical CMS Notification Mechanism of Assertion
Given the high stakes, health insurers need reliable solutions to make sure they always comply with CMS expectations. The CMS notification service by Assertion helps customer care providers ensure high quality of service in the following ways:
- Screening Incoming Calls: The solution reviews all incoming calls and checks if any call is from a CMS auditor.
- Real-Time Notifications: Whenever an auditor’s call is identified, a Microsoft Teams notification goes to the agent and supervisor within 10 seconds.
- Maintaining an Up-to-Date Database: The solution maintains a constantly updated database of phone numbers of these auditors; this ensures accuracy and reliability.
How It Works
Whenever Assertion Secure Voice detects a call from CMS auditor, an email is sent notifying the configured distribution list about it. Upon configuration in O365, this electronic mail sends its subject line directly to a selected Teams group thus alerting agents and supervisors instantly. This rapid notification system allows the service team to provide exceptional service, ensuring no critical calls are mishandled. The system also collects real-time feedback from agents who handle the calls and uses this information to update the database of CMS auditor phone numbers.
Conclusion
A solid CMS rating provides solid proof of an insurance company’s dedication to excellence in quality and service provision. Assertion’s C.M.S notification system helps insurers secure their ratings, protect their revenues, and build trust with consumers by ensuring each interaction with CMS auditors is faultless.
Contact Assertion Today on sales@assertion.cloud to help understand how we can help you achieve and maintain your 5-star rating on CMS.