CMS finds errors in almost half of physician listings in MA directories


A CMS survey found that nearly 46% of physician listings in Medicare Advantage (MA) directories contained incorrect information. Authorities fear that these inaccuracies will make it harder for older people to access the health care they need.

A CMS survey found that nearly 46% of physician listings in Medicare Advantage (MA) directories contained incorrect information. Authorities fear that these inaccuracies will make it harder for older people to access the health care they need.

The results of the CMS survey, which examined directory listings for a total of 5,832 providers in 54 MA plans, were announced at the United States National Health Insurance Plans (AHIP) conferences on Medicare. , Medicaid and Duals. The data was collected by CMS contractors who called each supplier to verify details such as name, address, specialty, and accepted insurance plans.

They found that the most common error occurred when vendors were listed as available at the wrong locations of their multi-site practices. Inaccurate addresses and phone numbers were also common, which were found for 633 and 521 of the vendors, respectively.

These results come from the first wave of the three-year CMS Lists Review project. CMS hopes its future surveys will show reduced error rates due to the federal rule enacted in 2016 that required every AM plan to contact providers in its network every 3 months to confirm registration information and update. update their directories “in real time”. The settlement also provides for penalties for inaccuracies, which could reach up to $ 25,000 per day per beneficiary.

CMS officials who presented the survey results at the conference explained that the errors were of concern as they could hinder older people ‘s access to finding a network doctor or specialist referral. .

With the increasing use of information technology (IT) at every stage of healthcare, previous research has examined inaccuracies in vendor listings for plans other than MA. A study published in Health affairs callers were posing as patients and trying to reach 743 providers in California who were listed in online directories. The results have been disheartening, with less than 30% able to make an appointment with the desired practitioner.

“Inaccurate supplier directories are difficult for patients trying to access suppliers, and they make it difficult for regulators to assess the adequacy of the network,” the authors wrote.

More often than not, study callers encountered obstacles due to inaccurate advertisements. 30% of callers found that the doctor they contacted did not practice the specialty in the information on the list, 20% could not contact the supplier at the given phone number, 10% were informed that the the doctor they sought was not practicing there, and 10% found that the doctor was not accepting new patients.


Comments are closed.