Is your brand monitoring its Provider Directory?
Provider Directory Compliance and Accuracy, as mandated by Centers for Medicare and Medicaid Services (CMS), protects your brand equity and minimizes risk. Second To None supports your organization in quickly determining and correcting provider directory inaccuracy, in order to minimize risk.
Provider Directory Compliance: Mitigate Risk
Health insurers must provide up-to-date doctor lists for their Medicare Advantage and Healthcare.gov policies, according to the Centers for Medicare & Medicaid Services. Second To None’s Provider Directory Compliance solutions can help you continuously and accurately understand how well your Provider Directory adheres to CMS requirements.
CMS has notified issuers of qualified health plans (QHPs) on the federal marketplace and insurers that issue Medicare Advantage plans of provider directory standards:
“A QHP issuer must publish an up-to-date, accurate, and complete provider directory, including information on which providers are accepting new patients, the provider’s location, contact information, specialty, medical group, and any institutional affiliations, in a manner that is easily accessible,” according to the letter to Healthcare.gov plans.
Issuers must update these directories each month and make them available in a machine-readable file and format, CMS said, “to allow the creation of user-friendly aggregated information sources.”
The requirement comes after CMS received reports that many Affordable Care Act plan enrollees struggled to find doctors who would accept them as patients.
Plans with directories that do not comply with the new CMS rules face stiff penalties–a maximum of $100 per day per individual adversely affected by a non-compliant QHP or dental plan and up to $25,000 per day per Medicare Advantage beneficiary, according to Kaiser Health News.
Provider Directory Compliance Audits help answer crucial questions:
Are all provider services currently accurate?
Are specialty services listed correctly and available?
Are services available to new patients?
Is patient access and languages spoken accurate?
Is all patient-facing contact and location information accurate?
Medicare Compliance Audits help answer crucial organizational questions:
Are sales agents appearing at planned events?
Are plans presented clearly and accurately?
Do consumers feel pressured or mislead into making a purchase decision?
Are alternative plans presented or mentioned in a disparaging manner?
Medicare, Managed Care and Healthplan Compliance audits can be enhanced in richness through optional gathering of video, audio and/or photographic images to supplement the detailed written reports.
Network and Directory Compliance audits are conducted across a statistically valid and tailored sample of your provider network. Near real-time results of deficiencies in provider directory information and provider office competencies are provided, allowing your organization to maintain compliance with new, emerging and anticipated provider network transparency requirements.
Our robust analytics and reporting services deliver clear, fact-based compliance insights to the right people at the right time, enabling you to focus with pinpoint accuracy on the most important action planning and priorities, at every level of your organization.
Integrated or Stand-Alone Programs | Unified Reporting + Analytics
Second To None is differentiated in our ability to offer Operationally-based measurement solutions – Mystery Shopping and Compliance Audits – along with Customer-based solutions Voice of Customer feedback surveys – then unifying data streams into a robust, real-time and role-specific Analytics and Insights platform.