New CMS Regulations Target Health Insurer Provider Directory Inaccuracies

As reported by Melinda Beck of the Wall Street Journal, health insurers may now face significant penalties under new regulations from the Centers for Medicare and Medicaid Services (CMS) for inaccuracies in their provider directories.

With the advent of these new regulations, health insurers may face fines “up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run exchanges in 37 states,” writes Beck.

These new regulations are in response to the problem of patients being unable to identify in-network providers due to directory inaccuracies. This can result in unforeseen high out-of-pocket costs for patients.

Directory inaccuracies arise, and have become so widespread, because of frequent changes in provider information. As Beck writes, “Keeping directories up-to-date is difficult in part because relationships between doctors and hospitals are complex and frequently changing. Many physicians see patients in multiple locations and may be in different insurance networks at each one. According to LexisNexis Risk Solutions data, 30% of U.S. doctors change affiliations every year.”

CMS’ new regulations call for insurers to update their directories by contacting providers on a quarterly basis to verify information.

For more information, access the full WSJ article here.