Medicare Directory Errors, or It Takes Two to Tango

Internet listings of doctors and other health professionals in Medicare Advantage plan networks are notoriously inaccurate.

The federal Medicare agency’s second review, released last week, found that 52 percent of provider directory locations listed had at least one mistake. That’s downhill from the first review when 45 percent of locations listed in these online directories were inaccurate.

The Medicare agency calls provider directories “an important tool MA enrollees use to select and contact their physicians.” So the inaccuracies could be a significant barrier to care because MA enrollees rely on the directories to locate an in-network provider.

But who’s to blame?

The agency says the MA plans are in the best position to ensure the accuracy of their own directories.

Indeed, the agency slapped the plans with 23 notices of noncompliance, 19 warning letters, and 12 warning letters with a request for a business plan after the second review.

But there are two sides and the source of the problem may not be clear cut.

American’s Health Insurance Plans, a trade group for the plans, conducted a pilot program in three states, testing ways for plans to coordinate with network doctors to verify directory data.

Here’s what the group’s spokeswoman told me:

Data accuracy depends on both doctors and health plans. Medicare Advantage plans depend on doctors to submit accurate and up-to-date information, she said.

However, some doctors contract with multiple health plans, and there’s no centralized or unified process for updating this information, she said. 

Another challenge for plans is that group practices continue to provide data at the group level rather than at the provider level. A group practice often lists a provider at a location because the group has an office there, even if the doctor never sees patients at that location.

CMS’s third review, now underway, will reveal if things are turning around following the public airing of the first two reviews.

Read my full story here.

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