Errors plague Medicare Advantage provider directories

cms

Errors in Medicare Advantage physician directories are common and could lead to bans on new enrollment or significant fines for health plans.

A new Centers for Medicare & Medicaid Services review revealed at a recent industry conference found that almost 46 percent of the 5,832 doctors listed in 54 private MA plans provided wrong information, limiting beneficiaries’ ability to get needed care.

The audit discovered that 521 providers listed wrong phone numbers, while another 633 offices gave incorrect physical addresses. Further, the report showed error rates greater than 60 percent for five of the 54 MA health plans examined. 

Digital Transformation

Unlock the Digital Front Door with an App

The Member Mobile App is the smarter and better way to engage members anytime and anywhere. Members can find the right doctors, receive alerts, track spending, use telehealth, and more — all within a guided, intuitive, and seamless experience. Built exclusively for payers, it is ready to install and launch in a few months. Request a consult on how to enable the digital front door with the Mobile App, today.

CMS opted to keep the insurers included in the review anonymous.

Officials said possible sources of the errors include a doctor retiring, working at a different location or never signing a contract with the MA health plan to begin with.

CMS has yet taken any compliance actions related to the errors, officials said during the presentation, but may do so in the future. Penalties could include fines of up to $25,000 a day per beneficiary or bans on new enrollment and marketing, notes a Kaiser Health News article.

An America’s Health Insurance Plans spokesman told KHN that the group recognizes that insurers need to improve their maintenance of provider directories to remain timely and accurate.

In other MA news, CMS Acting Director Michael Crochunis reached out to MA organizations in a letter to inform them that CMS is “temporarily suspending its acceptance" of any new, automatic re-enrollment proposals. Crochunis pointed to recent inquiries that have been brought to the attention of CMS regarding beneficiary safeguards as motivation for the suspension. 

Suggested Articles

Medicare Advantage premiums are set to hit their lowest rate since 2007, the Trump administration announced Thursday.

President Trump will sign an executive order today that declares it a national policy to protect patients with preexisting conditions.

One-third of primary care physicians say revenue and pay are still significantly lower and net losses threaten current and future viability.