According to a July 2016 study in Health Affairs, the details about physicians and other providers that appear in online and print network directories published by payers are often riddled with errors. Research shows that almost 50 percent of physician and provider directories contain incorrect physician information, which can impede timely, affordable, patient-focused care.
While the quality of directories is shockingly poor, physician leaders and practice managers highlight communication of this information as a point of significant administrative burden. Physicians and other providers often mention that they are overwhelmed by calls, emails and faxes from multiple payers trying to comply with federal and state regulations regarding the need to offer patients current and accurate directory information.
Real world costs of data quality
Inaccuracies in payers’ directories result in frustration for patient and physician alike, causing delays in the delivery of appropriate medical care and unplanned out-of-pocket expenses for patients. Practices report complaints from prospective patients when a payer directory incorrectly indicated that their desired physician was in-network or was accepting new patients. Likewise, physicians encounter financial and administrative issues when they treat patients only to learn subsequently that their services are not covered by the patient’s insurance. Patients can experience disruptions in care or out of network charges due to inaccurate directory information.
Patients frequently choose a health plan based on directory information because they believe the physicians from whom they want to seek care are in-network. And once a plan is chosen it cannot be easily changed, meaning that decisions based on flawed information can be disruptive to care for patients and their families.
New federal and state regulations are requiring payers to improve directory accuracy. Yet the AMA has long recognized this problem for physicians. In 2007 the AMA House of Delegates adopted a policy to address physician dissatisfaction with provider directories. Today, the issue is magnified because medical practices participate in an average of 12 managed-care contracts, requiring extensive administration.
Clearing the way for quality care
Now the AMA, through its subsidiary, AMA Business Solutions, has teamed up with industry leader LexisNexis® Risk Solutions to introduce VerifyHCP, a multifaceted clinician information management solution that includes a user-friendly online portal designed to enable practices to validate or update directory information—through one channel—for all participating health plans.
VerifyHCP, a comprehensive resource of offerings including portal, data analytics and more, launched this spring and is built upon the robust, combined data resources of the collaborators. Physicians whose payer plans enroll in the VerifyHCP online platform will benefit from the pre-fill functionality of the tool, minimizing the amount of manual data entry required of them or their practice managers. Users only have to login to edit and confirm practice-related information that has been gathered from multiple sources and preloaded into the database. Periodically, physicians will receive an email alert asking them to scroll quickly through directory details to confirm their accuracy for all of their participating payers—a process that can be completed quickly and easily.
“LexisNexis Health Care provides unique analytic technology and proven capabilities that complement the AMA’s extensive data resources and supports the important goal of providing patients with accurate network directories,” said Laurie McGraw, the AMA’s senior vice president of health solutions.
With confirmation of payer-directory information, VerifyHCP helps “patients access the reliable information they need to make informed decisions when selecting the right health plan or finding an appropriate physician,” McGraw added.
Because VerifyHCP can be used not only by physicians’ practices, but also by those of dentists, nurse practitioners, and other clinicians who accept patients under insurance plans, its service could have a profound and enduring impact on millions of health professionals and their patients.
“The AMA’s unique ability to reach, engage and represent physicians made them the perfect partner for us. It has never been more important for both operational and compliance purposes to identify, validate and update clinician data in real-time,” said Josh Schoeller, vice president of client engagement at LexisNexis Health Care. “Working in collaboration, the AMA, AMA Business Solutions and LexisNexis Health Care are offering a comprehensive and authoritative solution that delivers a flow of accurate data to meet state and federal directory mandates, and most importantly, supports the needs of patients, physicians and payers.”