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