Medicare Directory Errors: Could You Be Affected?

Posted By Jorgensen, Brownell & Pepin, P.C.

12 Apr. 2017

The Centers for Medicare & Medicaid Services (CMS) recently launched an in-depth review of Medicare Advantage provider directories, finding nearly 47% of the online directories had inaccuracies. These directories included incorrect locations, mistaken phone numbers, and some even listed information for providers that were no longer accepting new patients, had retired, or were deceased. These inaccuracies, the CMS argued, could prevent Medicare Advantage beneficiaries from receiving proper care.

Medicare Advantage is often used in lieu of standard Medicare because it comes with lower out-of-pocket costs. It also provides private insurers, rather than government-funded organizations, like standard Medicare. The government puts a set monthly fee towards Medicare Advantage plans to better provide services to the beneficiaries under the plan’s care. Typically, these plans are HMOs or PPOs and only cover doctors in their network, which is why so much rests on the accuracy of the directories the beneficiaries use to choose a provider. Choosing care outside of the network can be extremely costly and, therefore, not a preferred method of most beneficiaries.

The CMS took action to protect the more than 17 million Americans who receive care under Medicare Advantage by instructing providers with the most errors to make amends directly. Federal officials gave the 21 Medicare Advantage insurers with the most flawed directories approximately one month, or until February 6, 2017, to fix the mistakes. The consequences for failing to do so included heavy fines and a forced block on enrollment. Since 2016, the CMS has required providers to contact the doctors listed in their directories every 3 months to update the system, making these widespread mistakes inexcusable.

If you have Medicare Advantage, look over your provider and plan to double check that the information is accurate and reliable. The CMS plans to continue to examine all 300 companies by the end of 2018 to ensure similar mistakes never reoccur.

To learn more about the CMS review, click here.

For more information about how this could affect you, contact Jorgensen, Brownell & Pepin, P.C..

Categories: Medicaid
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