Medicare provider data maintained by CMS is often inconsistent, inaccurate and occasionally incomplete, according to a study by the Office of the Inspector General.
For the study, the OIG examined a random sample of individual Medicare providers to determine the accuracy of the information stored in the National Plan and Provider Enumeration System and the Provider Enrollment, Chain and Ownership System.
Provider information, including National Provider Identifiers, is stored in the NPPES, and is then supplied to CMS to be entered in PECOS when the provider is enrolling in Medicare.
The key findings of the study are:
• In the NPPES, provider data was inaccurate in 48 percent of the records. It was also incomplete for 9 percent of the records.
• In PECOS, provider data was inaccurate in 58 percent of the records and incomplete for almost 4 percent.
• Provider data was inconsistent between NPPES and PECOS for 97 percent of the records.
The OIG noted that inaccurate, incomplete and inconsistent provider data places the integrity of the Medicare program at risk.
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For the study, the OIG examined a random sample of individual Medicare providers to determine the accuracy of the information stored in the National Plan and Provider Enumeration System and the Provider Enrollment, Chain and Ownership System.
Provider information, including National Provider Identifiers, is stored in the NPPES, and is then supplied to CMS to be entered in PECOS when the provider is enrolling in Medicare.
The key findings of the study are:
• In the NPPES, provider data was inaccurate in 48 percent of the records. It was also incomplete for 9 percent of the records.
• In PECOS, provider data was inaccurate in 58 percent of the records and incomplete for almost 4 percent.
• Provider data was inconsistent between NPPES and PECOS for 97 percent of the records.
The OIG noted that inaccurate, incomplete and inconsistent provider data places the integrity of the Medicare program at risk.
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