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Medical Coding News Archives

MAO Provider Directories Frustrate Would-Be Patients, CMS Finds

 
February 14, 2018:

In a review completed in August 2017, the Centers for Medicare and Medicaid Services (CMS) discovered widespread errors in provider directories maintained by Medicare Advantage organizations (MAOs), which could pose significant barriers to patient care. Physicians are missing out on patients, and healthcare consumers are getting frustrated and misled.

In its review of online provider directories for 64 MAOs from September 2016 through August 2017, CMS focused on the most common provider types: cardiologist, oncologist, ophthalmologist, and primary care physician. It found that more than half of the locations listed had at least one error. Typical mistakes included the provider was not at the location noted, the phone number was incorrect, and the directory indicated the provider was accepting new patients when he or she was not or vice versa.

The error rate per MAO directory varied widely, from a low of 11.20 percent to a whopping 97.82 percent of entries. These rates are particularly troubling because CMS gave MAOs a heads up in 2016 that it would be verifying directory information for plans offered by MAOs.

Among the phone number errors were numbers of other businesses, the personal numbers of providers, and home numbers of unrelated individuals.

CMS identified a few reasons for the inaccuracies:

  • The directories rely on the location information for group practices rather than for the individual clinician. One clinician might erroneously be listed as if he or she practices at all of a group’s locations.
  • MAOs are not routinely reviewing the accuracy of their directory entries but rather relying on the integrity of the data provided by credentialing services, vendors, and providers.
  • Directories are not updated for years at a time. Some physicians listed were found to have retired or died years ago.

When a first, smaller directory review in the first half of 2016 started uncovering significant errors, CMS strengthened its guidance and relayed its concerns through a Health Plan Management System memo and two Call Letters to plans for calendar years 2016 and 2017.

In total, the directory review has prompted CMS to issue 23 notices of noncompliance, 19 warning letters, and 12 warning letters with requests for business plans.

The agency is encouraging MAOs to centralize data collection and verification but recognizes that doing so takes time. In the short-term, the organizations are urged to perform audits, clarify practice locations with group practices, and create an effective way for members to report directory errors.

Although CMS does not mention steps that physicians should be taking, providers would be wise to verify that they are listed in MAO directories, the information is correct, and their status as accepting or not accepting new patients is clear and accurate.

The agency is conducting its third and final directory review this year. This analysis will cover 50 MAOs.

 

 
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