Imagine if each time you entered an address into your GPS you only had a 50% shot that you would arrive at your correct location. You would be pretty upset if you weren’t in the 50% that made it to their destination. That is precisely what CMS has uncovered during round two of the online provider directory review. The average Medicare Advantage Organization’s inaccuracy rate by location was 48.39%. Nearly HALF of all directory locations reviewed are inaccurate. That high rate not only produces frustration, but a significant access-to-care barrier for members.
It’s clear that healthcare payers do not have the necessary monitoring and oversight built into their system to be compliant. Sure, it would be great for a central provider database to be available, but it’s not. Which means the responsibility is on the healthcare payer to work with their providers to ensure accurate data. Payers can’t assume that every time a provider needs to update their information that they will reach out. A proactive outreach program must be put in place by the payer to obtain new data and ensure current data is correct. Using contract execution or renewal dates is a great place to start. Incorporating outreach that is triggered on an annual basis by these dates can jump start the monitoring process.
And location is only one element of a larger problem. During CMS’s review they also found a number of providers who had either retired, were deceased or relocated for a number of years. Inaccurate provider directories impact the overall adequacy of a payer’s network. After round 2 of the review, 23 plans were issued a notice of non-compliance, 19 plans were issued warning letters and 12 were issue warning letters with a request for a business plan. It’s time to be proactive and change the way you do things. Don’t become a statistic and receive a letter from CMS, instead issue a letter to your providers that contains the data you have on file and encourage a response. Work together to see better results.
Imagine if each time you entered an address into your GPS you only had a 50% shot that you would arrive at your correct location. You would be pretty upset if you weren’t in the 50% that made it to their destination. That is precisely what CMS has uncovered during round two of the online provider directory review. The average […]
The Winter Olympics are here! If you’re like me, you’re looking forward to the excitement and thrills of international competition! I am a snowboarder so I have a personal love for winter sports and will be glued to my TV and social media feeds watching the events and keeping medal counts. There is such an inspirational culture built at the […]
Tis’ the season for Christmas cards! We take family photos, pick out a festive layout, print them out and prep for mailing. Seems pretty painless, right? Think again. If you are like me you have addresses stored in a spreadsheet that haven’t been updated in years. It makes sense to update it when you receive new mail from a friend […]
We all know the adage…you don’t know what you don’t know. Time and time again while working in the world of enterprise information software I see this first hand. We speak with managers and executives that don’t even realize how far enterprise information platforms have come or just how impactful they can be to your business process. To often we […]