The Centers for Medicare & Medicaid Services (CMS) recently
issued a wave of compliance actions against Medicare Advantage
Organizations (MAOs) for failing to maintain accurate online
provider directories. Prompted by complaints of deficiencies in the
directories, CMS had undertaken a study to test the accuracy of
information contained in them.
CMS's first review round, which studied 54 MAOs encompassing
a total of 5,832 providers (representing 11,646 locations), found
that over 45% of the provider directory locations studied were
inaccurate. Additionally, nearly 47% of providers in the review had
at least one deficiency. The types of errors identified included
incorrect phone numbers, inaccurate listings of locations where
providers offered services, and inaccuracies regarding whether or
not providers were accepting new patients. These deficiencies
appeared to result from group practices providing data at the group
level rather than at a provider level, MAOs employing a reactive
rather than a proactive approach to data integrity, and a general
lack of internal audit and testing of the directory by MAOs.
The second review round, which will examine directories of an
additional 64 MAOs, is currently in progress. Through its published
report of the first review round and the
resulting compliance actions, CMS has clearly communicated its
expectation that MAOs will correct errors and proactively
participate in maintaining the accuracy of provider directories.
MAOs that fail to respond can expect additional compliance action
by CMS which may include fines and sanctions.
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