Ensuring Benchmark Adherence in Call Center Operations
The Centers for Medicare & Medicaid Services (CMS) plays a pivotal role in ensuring an efficient healthcare system. Among its many oversight initiatives, CMS monitors the timeliness of call center response performance for Part C and Part D providers, pharmacy call centers, and Medicare Advantage operators. This effort supports a core commitment to improving member services and upholding operational excellence, ensuring beneficiaries receive the help they need promptly and effectively.
For the Quarter 4 study of 2024, CMS has conducted a thorough evaluation of call center performance. Below, we detail the monitoring period, access to performance metric reports, guidelines to review call-level data, and the critical steps providers must take to ensure compliance by the January 28, 2025, deadline.
Monitoring Period for Call Centers
CMS evaluated call center response timeliness between October 21, 2024, and November 15, 2024. Monitoring was conducted during the following hours of operation for each service area:
- Part C and Part D beneficiary customer service call centers
- Hours: Monday through Friday, 8 a.m. to 8 p.m.
- Focused on monitoring response timeliness for current enrollees during peak operation hours.
- Pharmacy technical help desk call centers
- Hours: 24/7 monitoring (Monday through Friday, 24-hour operation).
- Ensured round-the-clock availability to handle technical support inquiries efficiently.
This structured schedule allows CMS to gather granular data on peak hours and ensure continuous service excellence.
Data Sets Available in HPMS
Following the monitoring period, CMS has made two crucial data sets available through the Health Plan Management System (HPMS) for analysis and review by providers and stakeholders. These data sets provide deep insights into call center performance and areas needing improvement:
1. Call Center Timeliness Performance Metrics Data
This dataset includes key metrics such as average hold times, response times, and disconnect rates. It serves as a high-level overview of call center efficiency and compliance with CMS standards.
2. Call-Level Raw Data
This detailed dataset offers granular insights, including individual call statistics, allowing providers to identify specific trends, patterns, and potential areas for intervention within their call center operations.
These datasets empower health plans and pharmacy operators to conduct data-driven reviews and implement improvements where necessary to meet timeliness standards.
Accessing Performance Metrics in HPMS
Providers can access their call center performance metrics in HPMS by following these clear instructions:
1. Login
- Visit the HPMS portal at https://hpms.cms.gov.
- Use your authorized credentials to log into your account.
2. Navigate to Performance Metrics
- Go to Quality and Performance > Performance Metrics > Reports tab.
- From the dropdown menu, select Call Center Monitoring.
3. Configure Report Parameters
- Choose the appropriate Report Type (e.g., Part C Beneficiary Customer Service, Part D Beneficiary Customer Service, or Pharmacy Support Customer Service).
- Select the Report Period by navigating to the monitoring week of interest. For Quarter 4 results, select November 11 – November 15, 2024, to view the complete quarterly data.
4. Input Contract Information
- Enter the Contract ID or select from the prebuilt list of contract IDs available within the HPMS.
h5. Generate and Download Reports
- Click the Create Report button to review the data in HPMS.
- Alternatively, select the Download button to export metrics in Excel format for offline review and analysis.
Reminder: For complete quarter results, ensure you select the cumulative (year-to-date) option within the report filter.
Accessing Raw Data in HPMS
To dig deeper into underlying performance details, follow these steps to access and download call-level raw data for your contract(s):
- Follow the steps above to access and generate the performance metrics report.
- Download Raw Data:
- Locate the Download button within the performance metrics tool.
- Choose the option titled Cumulative Raw Data for [Contract Name] for an individual contract or select Cumulative Raw Data for All Contracts for bulk download.
- Review Supporting Documentation:
- Use the accompanying Data Dictionary for Raw Data and Technical Notes for a clearer understanding of the dataset’s structure and field properties.
This approach ensures a highly detailed review of call center operations, helping providers pinpoint specific calls contributing to performance gaps.
Questions or Concerns? Contact CMS
Providers seeking clarification about their data or needing further support can connect directly with CMS via the Call Center Monitoring Mailbox at CallCenterMonitoring@cms.hhs.gov.
Reach out promptly with any concerns to ensure adequate time to address issues before the January 28, 2025, deadline.
Key Deadline for Review
All providers must complete their review of call center performance data no later than January 28, 2025. This timeline ensures that providers can analyze their performance, address discrepancies, and implement corrective measures, as necessary, to align with Medicare’s standards for response timeliness and service quality.
Failure to review and act before this deadline risks operational penalties and reputational harm, emphasizing the urgency of completing this vital compliance task.
Take Action to Optimize Call Center Performance
CMS’s Quarter 4 Call Center Monitoring Study highlights the importance of maintaining high-quality member services for Medicare Advantage, Part C, and Part D beneficiaries. By accessing and analyzing the metrics through HPMS, health plans can identify key opportunities to improve timeliness, reduce member dissatisfaction, and strengthen operational workflows.
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