Patient Support & Advocacy

Directory-related mishaps affect patients monthly, say doctors

More than half of physicians who responded to a recent survey (52 percent) noted they have a patient who encounters coverage issues because of inaccurate payer directories every single month.

The inaccuracies have prompted a regulatory response. The Centers for Medicare & Medicaid Services (CMS) and state legislative bodies have issued regulations to ensure physician directory accuracy across the industry. Additionally, there is substantial variability among state rules.

Yet a 2017 federal audit of network directories published by Medicare Advantage plans found that 52 percent of the provider locations listed had at least one inaccuracy. That is actually worse than a 2016 CMS review that found 45 percent of provider directory locations listed in online directories were wrong.

The inaccurate information listed in payer directories covers basic data points that can directly affect a patient’s ability to receive care, such as:

  • The physician’s practice address.
  • The practice’s telephone number.
  • Whether the physician is in or out of network.
  • Whether the physician is accepting new patients.

Both payers and physicians need to take a hard look at the process. This is a shared responsibility between them. Overwhelmingly, physicians believe it is important to be represented accurately in payer directories (89 percent), yet most (73 percent) are not even aware of mandates related to the accuracy of payer directories.

Payers need to work together to make the process as easy as possible and commit to updating their directories in a timely manner when they receive information from a physician or their practice.  For their part, physicians and practices need to ensure they are providing timely, accurate updates to the payers they work with when things change.   

“Recognizing the importance to patients of high-quality directories, federal and state governments have created regulations requiring health plans to increase the frequency of physician data verification,” said Laurie McGraw, senior vice president of AMA Health Solutions. “As a consequence, some physician offices have experienced an increase in repetitious data verification requests from health plans that are mandated to constantly ensure the quality of network directories.”

Nearly half of the physicians surveyed said they get requests for updates from payers. Almost 70 percent of physicians provide information directory updates to payers, and they do so mainly by fax.

Related Coverage

New service boosts accuracy of physician, provider directories

The physician survey was released by the AMA and LexisNexis as part of a collaboration that offers physicians and health plans a centralized solution, VerifyHCP™, which delivers data to facilitate meeting state and federal directory mandates and ultimately enable patient care.

The AMA and it subsidiary AMA Business Solutions collaborated with LexisNexis® Risk Solutions to truly solve the problem with VerifyHCP. The solution combines robust data analytics with streamlined physician outreach making it unnecessary for health plans to send physicians duplicative data-verification requests relieving physicians of the distraction from a barrage of uncoordinated requests from multiple health plans.

Most physicians surveyed expressed interest in having their practice use just one consolidated interface to send and update information about their providers to payers (67 percent).

VerifyHCP enables medical practices to validate or update directory information through one interface for all participating health plans. Most important, achieving directory accuracy helps patients avoid unnecessary delays or disruptions when seeking  care.