CMS: 45% of provider locations in Medicare Advantage directories are inaccurate

A CMS review of provider directories set up by Medicare Advantage (MA) plans found many listed the wrong phone numbers or locations for physicians or incorrectly labeled physicians as accepting new patients.

The review was conducted between February and August 2016 involving 54 Medicare Advantage organizations (MAOs) and more than 5,800 providers. More than 45 percent of locations listed for providers were incorrect, and some individual directories had error rates as high as 87 percent.

“Because MAO members rely on provider directories to locate an in-network provider, the accuracy of this information is critical,” the CMS report said. “Directories that include locations where a provider does not practice or state that providers are accepting new patients when they are not call into question the adequacy and validity of the MAO network as a whole. These inaccuracies can create barriers for members to receive services critical for their health and well-being.”

In the 54 MA plans reviewed, a total of 5,352 errors were found. The most common inaccuracy was listing the wrong location for a provider, with some directories containing multiple incorrect entries for the same provider.

“In about 1,162 of these cases, the provider associated with these locations did not work at any of the locations identified in the online directory,” the report said. “For example, if a provider were listed at three locations in the directory, CMS’s review found that the provider was not at any of the three locations identified. Given that the provider was not at any location listed in the directory, this finding raises concerns about whether these providers are even part of the network.”

The findings suggested MA plans aren’t reviewing their own directories to update entries or make sure the information is correct. It’s not the fault of a few organizations, according to CMS, noting only two organizations out of the 54 reviewed had deficiency rates below 20 percent.

Beyond MA plans’ lack of validation, the blame seems to fall on providers. The review said group practices appear to submit its directory data at the group level, rather than by provider, which leads to a physician being listed at locations where they rarely or never see patients. In some cases, doctors which have been retired or dead for years were still listed in directories, with MA plans assuming practices will inform them of any changes.

The onus on correcting entries, however, falls on the MA plans.

“We encourage MAOs to look for more near-term solutions to improving directory accuracy, such as performing self-audits of directory data, working with group practices to ensure that providers are only listed at locations where they accept appointments, and developing better internal processes for members to report directory errors,” the report concluded.

CMS is already conducting a second review of directories, expanding its examination to 64 MAOs.