Ritter Insurance Marketing, Craig Ritter

Errors Found in More than Half of MA Provider Directories

The Centers for Medicare and Medicaid Services (CMS) have found issues, yet again, with Medicare Advantage organization’s provider directories.

Upon a thorough investigation conducted from September 2016 to August 2017, CMS found that 52 percent of the provider directory locations listed contained at least one error. When CMS completed its first review from February to August 2016, 45 percent of locations were found to have at least one inaccuracy. Based on these statistics, it appears that the problem is only progressing.

CMS found that in many of these directories the provider was not at the location listed, the phone number was incorrect, and/or the provider was not accepting new patients when the directory indicated they were.

Sampling about one-third of all Medicare Advantage organizations, CMS covered directories across the board to keep their study credible. According to CMS, very few organizations performed well in the study.

These inaccuracies have caused some major problems for beneficiaries trying to seek medical attention. When the directories are not up to date, patients may go to a location thinking that doctor is in their network, when in fact, they’re not. This causes a significant access-to-care barrier for the patient.

In addition to causing frustration and hindering members from accessing care, these directory errors make the MAO network lose some of their credibility and validity.

CMS issued appropriate compliance actions to ensure improvement in the accuracy of provider directories and prevent problems like these from occurring in the future.

Posted by filed under CMS, Medicare Advantage .

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