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Avoid These 5 Common Compliance Mistakes

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 10:20 AM

Compliance Mistakes-1

Here are five common mistakes and what you can do to remain in compliance with the Centers for Medicare and Medicaid Services (CMS) when working with Medicare beneficiaries on their coverage.



1. Not Keeping SOAs on File
Beneficiaries must sign a scope of appointment before discussing Medicare Advantage or Part D plans. Remember to have your client sign an SOA at every appointment, and keep the forms on file for 10 years.

2. Not Determining Health Care Providers
Before you can help someone with their Medicare plan, you need to know every physician and specialist that client sees. Compare current providers with those in their chosen plan’s network so their service isn’t disrupted.

3. Not Reviewing the Drug Formulary
An unexpected increase in prescription prices can quickly change the client-agent relationship. Be sure to review enrollment data and fix it on the spot so the application isn’t returned.

4. Not Discussing Summary of Benefits
Provide your client with this at the time they enroll, summarizing key features, such as covered benefits and cost sharing. This summary needs to be discussed prior to signature collection and verification of intent to enroll.

5. Not Submitting Applications on Time
Be sure to submit all applications in the required 24-48-hour time frame, after doublechecking all the details and ensuring the application is complete.

In this industry, we’re busy year-round, and unintentional mistakes can always happen. It’s important to stay on top of the application process and to know exactly what’s needed to remain compliant as we do business.


Tags: Compliance

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