A CMS investigation found that almost 46% of the doctor listings in Medicare Advantage (MA) directories contained incorrect information. Officials worry that these inaccuracies could make it more difficult for seniors to access the healthcare they need.
A CMS investigation found that almost 46% of the doctor listings in Medicare Advantage (MA) directories contained incorrect information. Officials worry that these inaccuracies could make it more difficult for seniors to access the healthcare they need.
The results of the CMS survey, which examined the directory listings for a total of 5832 providers in 54 MA plans, were announced during the America’s Health Insurance Plans (AHIP) National Conferences on Medicare, Medicaid & Duals. The data were gathered by CMS contractors who called each provider to verify details like name, address, specialty, and accepted insurance plans.
They found that the most common error occurred when providers were listed as being available at the incorrect locations of their multi-site practices. Also common were inaccurate addresses and phone numbers, which were found for 633 and 521 of the providers, respectively.
These findings are from the first wave of CMS’ 3-year listing review project. CMS hopes that its future surveys will show reduced error rates due to the federal rule enacted in 2016 that required every MA plan to contact the providers in its network every 3 months to confirm listing information and update their directories “in real time.” The regulation also dictates penalties for inaccuracies, which could reach as high as $25,000 a day per beneficiary.
The CMS officials who presented the survey results at the conference explained that the errors were concerning because they could impede access for senior citizens seeking an in-network physician or a specialist referral.
With the increasing use of information technology (IT) at every step of healthcare, previous research has scrutinized inaccuracies in provider listings for plans other than MA. A study published in Health Affairs had callers pose as patients and try to reach 743 providers in California who were listed in online directories. The results were discouraging, with less than 30% able to make an appointment with the desired practitioner.
"Inaccurate provider directories are challenging for patients attempting to access providers, and they make it difficult for regulators to assess network adequacy," the authors wrote.
More commonly, the study’s callers encountered obstacles due to inaccurate listings. 30% of callers found that the physician they contacted did not practice the specialty in the listing information, 20% were unable to contact the provider at the given phone number, 10% were told that the doctor they sought did not practice at that location, and 10% found that the physician did not accept new patients.
Bringing Connectivity to the Specialty Pharmacy Workflow
May 2nd 2024In a session during the final full day of conference activity at AXS24, experts from CVS Health and Surescripts emphasized the need to simplify the prescribing workflow for specialty medication through proactive messaging, automation, and interoperability.
Read More
Emily Goldberg Shares Insights as a Genetic Counselor for Breast Cancer Risk Screening
October 30th 2023On this episode of Managed Care Cast, Emily Goldberg, MS, CGC, a genetic counselor at JScreen, breaks down how genetic screening for breast cancer works and why it is so important to increase awareness and education around these screening tools available to patients who may be at risk for cancer.
Listen
AUA to Focus on Inclusive Care, Robotic Surgeries, and Future of Urology at 2024 Annual Meeting
May 1st 2024The American Urological Association (AUA) 2024 Annual Meeting will highlight the latest innovations and future trends in urology, featuring dynamic plenary sessions, educational opportunities for providers, and discussions on cutting-edge treatments and global health initiatives.
Read More
Examining Telehealth Uptake to Increase Equitable Care Access
January 26th 2023To mark the publication of The American Journal of Managed Care®’s 12th annual health IT issue, on this episode of Managed Care Cast, we speak with Christopher M. Whaley, PhD, health care economist at the RAND Corporation, who focuses on health economics issues, including the influence of the COVID-19 pandemic on health care delivery.
Listen
Forging a Patient-Centric Path to Revolutionize and Redefine Value-Based Care
April 30th 2024Optum Life Sciences and Takeda Pharmaceuticals are partnering on an innovative virtual care pilot program for inflammatory bowel disease meant to both continue the mission of the current value-based health care landscape and raise the bar for personalized care delivery optimization.
Read More