CMS to monitor Medicare Advantage provider directories
- The CMS is calling out Medicare Advantage insurers that don't show accurate and up-to-date lists of available, in-network providers. The agency included new provisions in its proposed 2016 rate notice on Friday that indicate it may fine or sanction plans that fail to do so.
- The CMS writes that it "has become aware of a range of issues with online provider directories" that include listed providers who have left the network, retired, moved or died, or simply aren't accepting new patients.
- By 2017, the CMS says, it may require insurers to list provider information in standardized electronic formats that provide transparency and can be updated in real time.
The CMS now wants insurers to update their provider information—including whether the providers are accepting new patients—at least four times each year. The agency is also looking for insurers to correct mistakes in their directories and to implement a process to assist members who are denied access to an in-network provider.
The agency notes that it has already secured additional funding to verify the accuracy of Medicare Advantage plans' online provider directories.
As Modern Healthcare notes, CMS is also planning to increase its audits of Medicare Advantage plans this year and to levy penalties on those that "fail to maintain complete and accurate directories" or that fail to provide an adequate network of providers that are accepting new patients.
- Modern Healthcare Medicare may penalize Advantage plans for faulty provider lists