Call Center Monitoring — Star Rating Measure Tips for Success

Call Center Monitoring is one of your first Star Rating measures of the new contract year. Starting in February 2023, CMS will measure interpreter and TTY availability as a metric for the CY24 Star Ratings. Monitoring calls will be placed on your prospective enrollee call center phone lines. These calls will measure interpreter availability, TTY functionality, and accuracy of plan information. The accuracy of information is not included in the Star Ratings.

Call Center Monitoring

There are two measures in the Star Ratings:

  • C28 – Call Center – Foreign Language Interpreter and TTY Availability, and
  • D01 – Call Center – Foreign Language Interpreter and TTY Availability

The higher the rate of access, the better the score. These measures have a weight of 4 for Measures Capturing Access, so effort should be made to ensure that interpreters are readily available, and your TTY system is functioning correctly. CMS describes access measures as those processes and issues that could create barriers to receiving needed care. CMS assigns the highest weight to the improvement measures, followed by patient experience/complaints and access measures, then outcome and intermediate outcome measures, and finally, process measures.

The Star Rating measure is the percent of time that TTY services and foreign language interpretation were available when needed by people who called the health plan’s prospective enrollee customer-service phone line. This is calculated as the number of completed contacts with the interpreter and TTY, divided by the number of attempted contacts. A completed contact with an interpreter, is defined as establishing contact with an interpreter and confirming that the customer service representative can answer questions about the plan’s Medicare Part C/Part D benefit within eight minutes. Completed TTY contact is defined as establishing contact with and confirming that the customer service representative can answer questions about the plan’s Medicare Part C/Part D benefit within seven minutes.

Tips for Call Center Monitoring Success

  • Provide basic services and information to individuals with disabilities upon request.
  • Make all plan materials and information available in alternate formats (e.g., braille, large print, audio, and data CDs, and in requested alternate languages), upon request.
  • Monitor your interpreter phone line for responsiveness and access.
  • Test your TTY line to ensure calls can be received and responses provided.
  • Train representatives to respond to the opening question of “Are you the right person to answer questions about….” with “Yes” or offer a warm transfer to the correct department.

Separately, CMS also monitors hold time and disconnect rate. Quarterly reports are posted in HPMS. This monitoring measures current enrollee call center performance, Monday – Friday, 8 AM – 8 PM, and pharmacy technical help desk call center performance Monday – Friday, 24 hours a day.

We’re Here to Help

Cody Consulting helps by applying an objective review of your call center performance. We make test calls and look at your data and call center reports, including interpreter services, to identify areas for improvement. Since minutes and seconds count, we ensure calls are transferred quickly and answered within the required timeframe. When using a vendor for interpreters, be sure they are aware of the speed-to-answer and monitor their performance on a regular basis.

The 2023 Performance Metrics for the Accuracy and Accessibility Study will be available for review in July—but don’t wait. Contact us today to review and assess your current performance and identify areas for improvement to reach the high access rate. Now is the time to take action to support higher scores in CMS Star Ratings and oversight activities and avoid CMS compliance actions.

About us: CODY® has worked with over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico. We help align internal operations with CMS guidelines to improve regulatory compliance, maximize performance, and streamline member/provider communications across the enterprise. CodySoft® and Membership Suite™, our proprietary suites of software, are designed specifically for health plans.