The CMS is developing a pilot initiative that will test the accuracy of Medicare Advantage and Part D plan provider directories.
Under the initiative known as the Provider Network Accuracy pilot, the CMS will select plans at random and call providers in their directories to ensure that they are still contracted with the plan and that addresses and phone numbers are correct. The agency will notify plans of errors.
The agency will then wait at least 30 days and check if an update has been made. If nothing has been updated, it will again alert the plan. If a Medicare Advantage or Part D plan again doesn't update its directory then, it will face fines and enrollment sanctions, the agency said in a notice to MA and Part D plans.
The agency didn't say when the pilot would be launched. A CMS spokesman didn't immediately respond to a request for comment.
Late last month, America's Health Insurance Plans announced it too was launching a pilot to ensure provider directory accuracy. This one will have a wider reach, as it will target commercial, Medicaid, and Medicare plans.
The goal is for plans to check the accuracy of their directories, industry experts say.
“At the heart of this initiative is the reality that all too often when a provider moves out of state, changes network midyear or closes access to new patients, it is the plan that is the last to know,” Marissa Feigen, associate marketing manager at Cierant Corp., a marketing software and services company, said in an analysis of the pilot.
Provider groups support the pilot.
“What we hear a lot is that a provider will tell a plan if there's been a change, but plans aren't updating directories in a timely manner,” said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association. “So I think (the pilot) is a good way to address the situation.”
“Unfortunately, too often patients are getting erroneous or incomplete information," a spokesman for the American Medical Association added.
The AMA has been calling for stronger regulation of provider directories and protections for patients.
Some providers are concerned that employees at practices might be burdened by the time spent having phone conversations with agency officials, especially if there are no changes to report and if the pilot motivates plans to more regularly call providers themselves, according to Dr. John Meigs, president-elect of the American Academy of Family Physicians.
In AHIP's plan, instead of provider practices receiving requests or inquiries from multiple health plans, they will be contacted by either BetterDoctor and Availity, two healthcare information and technology firms, who will then share the information across plans participating in the pilot.
“Updating and maintaining provider directories is a shared responsibility between health plans and providers,” AHIP CEO Marilyn Tavenner said in a statement. “This latest pilot effort is designed to proactively address gaps in reporting in order to improve the experience for consumers and simplify the process for providers."