From February to August, the Centers for Medicare & Medicaid Services (CMS) conducted the second round of online provider directory reviews of 64 Medicare Advantage Organizations (MAOs). CMS reviewed online provider directories of 54 MAOs in 2016. Whether your organization has undergone an online provider directory review by CMS, and you’re remediating deficiencies, or you have yet to be picked, you’re going to want BluePeak Advisors’ Provider Directory Review service.
What began as a beneficiary complaint is now an annual review of online provider directories by the CMS that resulted in compliance action for 52 of 54 plans reviewed in 2016:
|Number of Plans||Deficiency Score Range||Compliance Action|
|2||1.77% – 4.63%||No Compliance Action|
|31||19.66% – 39.48%||Notice of Non-Compliance|
|18||41.37% – 58.79%||Warning Letter|
|3||65.08% – 70.75%||Notice of Non-Compliance with Request for a Business Plan|
The top two deficiencies were “Provider not listed in the directory at this location,” 45.9%, and “Provider should not be listed at any of the directory-indicated locations,” 21.7%. Other deficiencies included wrong addresses and phone numbers, provider is/not accepting new patients, and provider name/specialty needs to be updated.
In their Online Provider Directory Review Report, one of CMS’ recommendations to improve directory accuracy is for plans to do self-audits of their directory data. BluePeak began conducting online provider directory reviews in 2016, using the same review and scoring methodologies as CMS. Whether your team needs to prepare for an online provider directory review or remediate deficiencies found during a CMS review, BluePeak’s seasoned consultants can help.