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Topic: Agent Oversight
While the industry patiently awaits the Final 2018 Medicare Marketing Guidelines (MMG), learn which draft guidelines could have a huge impact on the industry if made final.
Are you considering adding agents/brokers to your sales force? Will these agents/brokers be exclusive or non-exclusive? If you are a health plan preparing to expand into a multi-channel sales approach, Gorman Health Group (GHG) recommends considering two types of agent/broker distribution sales channels: 1) Captive Agent/Broker and 2) External Agent/Broker.
As we head into bid and application season, one of the common needs that comes to mind is systems. While everyone acknowledges the need for a claims or enrollment system, there are often functions throughout the organization that can benefit from the efficiency and productivity of an automated process. One such example is agent management.
Imagine entering University and enrolling into Advanced French Language and Literature, a 300-level class, with no previous knowledge or study of the French language. As your professor welcomes you into class with bonjour, bienvenue, ça va, you have no idea how to reply. Now imagine sticking with that course for the full semester, trying to understand complex language and reading concepts without the foundation or basics. It would be quite an overwhelming few months for anyone.
All agents are expected to comply with the Centers for Medicare & Medicaid Services (CMS) regulations and guidelines, federal and state laws, and health plan rules, policies, and procedures. But what does that mean, and how can health plans enable their employed sales staff and contracted agents to stay compliant while achieving target goals and growth?
Time and time again, we encounter “the coolest workarounds” ever invented within the government programs space. Said a different way, we encounter staff who are stuck inventing ways to accomplish the regulatory burden upon their shoulders when they don’t have the right processes and tools to efficiently do their job. The manual effort and workarounds almost get the job done but ultimately leave the plan short of their end goal. This phenomenon is not just seen in one operational area but is commonly experienced across multiple disciplines within the health plan.
Agent compensation for Medicare Advantage has changed drastically since the implementation of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. MIPPA included regulations, for the first time, around Agent/Broker Commission – among many other things. The goal of implementing commission requirements was to ensure there was a level playing field between plans by implementing the Fair Market Value (FMV) limits, thereby removing the incentive for agents/brokers to enroll a beneficiary into the top-paying plan or to churn beneficiaries from one plan to another. Rather, the goal was to ensure the beneficiary was enrolled in the plan that best fit his/her needs.