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.
A couple years ago when I started thinking about running my first half marathon I knew it was going to be a real project and a real commitment. See, running doesn’t come easily or naturally to me and I don’t hesitate to say I’m usually bringing up the rear in most of my races. Although I’ve been an athlete my […]
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 […]
MILWAUKEE, February 21, 2018 – Leading enterprise information management system integrator Kiriworks, Inc. wrapped up a strong year by accepting Gold and Diamond Support honors from Hyland. This is the tenth consecutive year that Kiriworks has been awarded high honors for their excellence in developing, implementing and supporting OnBase solutions. One of the keys to Kiriworks’ success over the past […]
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 […]