CMS Finds Errors in Almost Half of Doctor Listings in MA Directories

A CMS investigation found that almost 46% of the doctor listings in Medicare Advantage (MA) directories contained incorrect information. Officials worry that these inaccuracies could make it more difficult for seniors to access the healthcare they need.

The results of the CMS survey, which examined the directory listings for a total of 5832 providers in 54 MA plans, were announced during the America’s Health Insurance Plans (AHIP) National Conferences on Medicare, Medicaid & Duals. The data were gathered by CMS contractors who called each provider to verify details like name, address, specialty, and accepted insurance plans.

They found that the most common error occurred when providers were listed as being available at the incorrect locations of their multi-site practices. Also common were inaccurate addresses and phone numbers, which were found for 633 and 521 of the providers, respectively.

These findings are from the first wave of CMS’ 3-year listing review project. CMS hopes that its future surveys will show reduced error rates due to the federal rule enacted in 2016 that required every MA plan to contact the providers in its network every 3 months to confirm listing information and update their directories “in real time.” The regulation also dictates penalties for inaccuracies, which could reach as high as $25,000 a day per beneficiary.

The CMS officials who presented the survey results at the conference explained that the errors were concerning because they could impede access for senior citizens seeking an in-network physician or a specialist referral.

With the increasing use of information technology (IT) at every step of healthcare, previous research has scrutinized inaccuracies in provider listings for plans other than MA. A study published in Health Affairs had callers pose as patients and try to reach 743 providers in California who were listed in online directories. The results were discouraging, with less than 30% able to make an appointment with the desired practitioner.

"Inaccurate provider directories are challenging for patients attempting to access providers, and they make it difficult for regulators to assess network adequacy," the authors wrote.

More commonly, the study’s callers encountered obstacles due to inaccurate listings. 30% of callers found that the physician they contacted did not practice the specialty in the listing information, 20% were unable to contact the provider at the given phone number, 10% were told that the doctor they sought did not practice at that location, and 10% found that the physician did not accept new patients.