How LSA Helped Maximize CMS Star Ratings & Ensure Compliance

Who is the client?

The Client is one of the largest health insurers in the US, delivering a comprehensive range of services. They offer medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans to promote whole health.

Industry.

Health Insurance Provider

Services Provided.

Over the Phone Interpretation
Video Remote Interpretation
Onsite Interpretation
Compliance Initiatives
CMS Planning

Over the Phone Interpretation

Video Remote
Interpretation

Onsite
Interpretation

Compliance
Initiatives

CMS
Planning

Operational Overview.

LSA has been providing language services to this Client since 2005. The Client began to migrate more business to LSA in 2016, and by 2023, our support expanded significantly across multiple states, dozens of business units, and numerous service lines. LSA has worked with this Client to improve customer satisfaction and provide language support whenever and wherever needed. This partnership has dramatically improved the experience for members and providers, and increased agent satisfaction with over the phone interpretation, virtual appointments, and last-minute onsite interpretation emergencies.

Business Challenges.

Preventing the Business Impact of a Poor CMS Star Rating

During CMS’ (The Centers for Medicare & Medicaid Services) Call Center Monitoring season, the Client recognized key metrics indicated their current language support vendors could not meet the stringent requirements of connect times and quality, which could negatively impact call center monitoring performance scores. A poor rating is available to the public during enrollment season and determines the Quality Bonus Payments and Medicare Advantage rebate a plan receives. A negative star rating can affect funding and decrease enrollment. The potential of a negative star rating during the CMS Call Center Monitoring season could significantly impact the Client. The Client needed an experienced team with a clear strategy to step in and implement a plan to improve their call centers’ performance during the Accuracy & Accessibility Study.

Keeping up with Compliance

The Client needed a language service provider (LSP) able to support all Federal and State compliance requirements and audit documentation requests. Operating in multiple states, each with unique regulations, requires an LSP with an experienced compliance team that understands the nuanced documentation and regulatory requirements. Unfortunately, the Client’s teams were met with opposition when attempting to work with LSP compliance departments to provide the required documentation and perform the necessary audits to satisfy obligations at State and Federal levels.

SOLUTIONS DELIVERED.

A Knowledgeable Team and a Coordinated CMS Strategy

LSA began implementing a turnaround strategy to improve connect times and call efficiency, which impacted CMS Call Center Monitoring scores. With its knowledge, experience, and understanding of CMS requirements, the LSA team improved the Client’s CMS-specific call handling and achieved maximum resource allocation to ensure call efficiency. LSA’s CMS and Quality teams engaged our network of highly qualified interpreters with rigorous assessments to ensure they understood the complexities and processes required for the CMS Call Center Monitoring season. The steps taken by LSA resulted in a significant positive impact during this critical period, leading to a continued partnership with expanded services. LSA’s experience working directly with CMS provided the Client with new tools to enhance its relationship with the agency.

An Experienced Team, Knowledgeable Staff, and Regular Correspondence

LSA was able to bring the staff and expertise needed to meet the frequent and often complicated compliance requirements the Client encounters. With an experienced team always willing to engage and partner with the Client, LSA has been able to assist with any questions, and continues to help even with the most minute details – we understand their importance. From complex and lengthy audits to impromptu meetings, LSA’s compliance team is always prepared to provide support wherever it’s needed. LSA is constantly researching and staying ahead of the curve when it comes to compliance, and we are 100% focused on the success of our Clients’ language services program.

Service Highlights & Real Results.

Open communication between the teams for full support.

CMS testing support from start to finish.

LSA provided the staff and expertise needed to meet complicated compliance requirements.

Improved CMS Star Rating.

Ensured compliance with all federal and state requirements.

24/7/365 support.

The LSA Difference.

With over 30 years of experience, a network of thousands of qualified interpreters, and hundreds of languages available, we are the best interpretation and translation partner in the healthcare industry. Contact us today to learn how we can help you stay compliant and improve your CMS Star Rating.