Errors included the provider not being at the location listed, an inaccurate phone number or the physician not accepting new patients when the directory stated they were.

A year ago the Centers for Medicare and Medicaid revealed many inaccuracies in the online provider directories a Medicare patient uses to research and find a doctor.

Fast forward 12 months and another test of Medicare online provider directories reveals that little, if any progress, has been made—even in the wake of monetary fines and other penalties from the federal government against the healthcare payers and other companies it pays to administer Medicare.

We encountered several instances where a call to a provider’s office resulted in determining that the provider had been retired or deceased for a long period of time, sometimes years.

Over the year from September 2016 through August 2017, the Centers for Medicare and Medicaid examined the accuracy of 108 providers selected from 64 Medicare Advantage Organizations. Collectively those Medicare Advantage Organizations accounted for 6,941 providers at 14,869 facilities.

The results of the review revealed at least one inaccuracy at 52% of Medicare Advantage Organizations studied. Errors included the provider not being at the location listed, an inaccurate phone number or the physician not accepting new patients when the directory stated they were. “The majority of the MAOs (37/54) had between 30% and 60% inaccurate locations,” says a new report from the Centers for Medicare and Medicaid Services. “Because MAO members rely on provider directories to locate an in-network provider, these inaccuracies pose a significant access to care barrier.”

The federal government report didn’t identify which specific Medicare Advantage Organizations had the most mistake-prone online directory. The range of provider directories with inaccurate locations went from 11.2% to nearly 100%, with one Medicare Advantage Organization having a facility location inaccuracy rate of 97.8%.

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In early 2017 the federal government put 21 major health insurance companies that administer Medicare plans on notice that they have major problems with the accuracy of their online provider directories. A government report found almost half of the 5,832 doctors listed had incorrect information, including wrong addresses and wrong phone numbers. Most health plans had inaccurate information for between 30% and 60% of their providers’ offices. The scoring methodology used by the Center for Medicare and Medicaid Services measured the number of bad metrics CMS researchers found in each Medicare provider directory. CMS use the number of errors to develop what it calls its deficiency score.

In its latest review the Centers for Medicare and Medicaid found:

  • Among 4,754 total dermatologist listings in the largest Medicare plans in 12 metropolitan areas, 45.5% represented duplicates in the same plan directory. Among the remaining listings, only 48.9% of dermatologists were reachable, accepted the listed plan and offered a patient appointment.
  • Of the 5,832 providers in the review, 46.9% (2,737) had at least one deficiency.
  • Of the 11,646 locations reviewed 45.1% (5,257) had at least one mistake.
  • The review uncovered 521 instances where the phone number was incorrect or disconnected. In some cases directories listed phone numbers of other businesses, providers’ personal phone numbers or actual home numbers of random individuals.
  • The category “Providers not accepting new patients” was identified as a deficiency 338 times because the online directory stated that the provider was accepting new patients and they were not..

“We identified several common drivers that may be contributing to provider directory inaccuracies,” the report says. “First, group practices appear to provide data at the group level rather than at the provider level, and second we saw a general lack of internal audit and testing of directory accuracy among many MAOs.”

The Centers for Medicare and Medicaid also found many non-practicing physicians that should have been removed from the directory. “We encountered several instances where a call to a provider’s office resulted in determining that the provider had been retired or deceased for a long period of time, sometimes years,” the report says.

The federal government noted it was cracking down on Medicare Advantage Organizations with various warning letters and deadlines to submit to “fix it” specifications and to do so inside 30 days.

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