Medicare Advantage organizations have some work to do to repair inaccuracies in their online provider directories, according to a CMS report.
CMS recently completed its first review round of Medicare Advantage online provider directories. The first review round, which was completed between February and August of 2016, included 54 Medicare Advantage organizations encompassing a total of 5,832 providers reviewed (representing 11,646 locations). Each Medicare Advantage organization had 108 providers reviewed, with provider types including cardiologist, oncologist, ophthalmologist and primary care physicians.
According to the report, CMS found 45.1 percent of provider directory locations listed in these online directories were inaccurate. The agency said types of inaccuracies included providers not at the location listed, an incorrect phone number, or the provider was not accepting new patients when the directory indicated they were.
CMS said within each Medicare Advantage organization directory, the percent of inaccurate locations ranged from 1.77 percent to 86.53 percent, with an average inaccuracy rate by location of 41.37 percent across the Medicare Advantage organizations reviewed. Of the 54 Medicare Advantage organizations reviewed, 37 had between 30 percent and 60 percent inaccurate locations, according to the agency.
"Because MAO members rely on provider directories to locate an in-network provider, these inaccuracies pose a significant access to care barrier. Inaccuracies with the highest likelihood of preventing access to care were found in 38.4 percent of all locations," CMS said.
In response to its findings, CMS said it has issued compliance actions, including notices of noncompliance, warning letters and warning letters with a request for a business plan. The agency encouraged Medicare Advantage organizations to look for more near-term solutions to improving directory accuracy. CMS said these solutions could include self-auditing, partnering with group practices to make sure providers are only listed at locations where they accept appointments, and improving internal processes for members to report directory errors.
CMS said it is currently conducting the second review round which will examine online provider directories of 64 additional Medicare Advantage organizations.