Author: Cheryl Cisneros, RN, CPCS, CPMSM, Manager, Client Success Services and Consulting, VerityStream
The Centers for Medicare and Medicaid Services (CMS) recently released the results of the Medicare Advantage Organization (MAO) online provider directory reviews. This is the third round of annual audits reviewing 5,602 providers at 10,504 locations.
The results of the audit found that overall, 48.74% of provider locations and had at least one deficiency. The importance of accurate provider directories is crucial to ensure a patient’s access to care.
Round One 45.10% Overall Inaccuracy
Round Two 55.07& Overall Inaccuracy
Round Three 48.74% Overall Inaccuracy
Common provider types were selected as a focus for the three consecutive annual reviews. The provider types are Primary Care Physicians, Cardiologists, Oncologists, and Ophthalmologists. 50.14% of providers had at least one deficiency.
#1 Provider should not be listed in the directory at this location
#2 Provider should not be listed at any of the directory-indicated locations
#3 Phone Number needs to be updated (incorrect or disconnected)
#4 Address needs to be updated
#5 Address (suite number) needs to be updated
CMS noted the following observations driving inaccurate provider directories:
18 Non-Compliance Notices
15 Warning Letters
7 Warning Letters with a Request for Business Plan
Implement an internal audit process. CMS has provided the questions which they survey.
Use this list in your internal reviews so you can answer “yes” when asked if your organization is ready for the next CMS Audit.