Don't Let Your Provider Directory Cost You Big Money

Nobody likes an audit, but they’re put in place to catch mistakes and make sure things are running as they are supposed to. In many industries, an audit can uncover inefficiencies and problems that can prevent a business from doing better. In the healthcare industry, however, audits can unveil problems that not only pose problems for medical facilities, but also situations that can inhibit patients’ health.

According to, several insurers could receive stiff penalties during the month of February due to errors uncovered during a recent in-depth review by the Federal Government. Many of these errors were largely focused around something that’s seemingly easy to remedy, yet often goes unnoticed — Provider directory errors.

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Why is it important to keep healthcare directories updated?

This may seem like a trivial task, but skipping healthcare directory updates could come back to haunt your company in the long run with the risk of significant fines.

Medicare Advantage offers patients the opportunity to seek coverage through private providers as an alternative to traditional Medicare. This means patients rely on provider directories to guide them toward in-network physicians. According to the information obtained by, approximately one-third of Medicare beneficiaries, or 17 million Americans, utilize private Medicare Advantage plans to obtain healthcare.

If your provider directory is outdated, your organization is posing a significant access-to-care barrier, which could be quite costly. Federal agencies are now paying attention to this type of deficiency, and stiff penalties could be warranted if your organization is subjected to an audit.

What types of provider directory errors trigger penalties?

In reality, any error in your provider directory could be subject to penalty; however, the findings of the recent Centers for Medicare & Medicaid Services (CMS) audit identified a few main factors relative to the providers, including the following:

  • Wrong addresses
  • Incorrect phone numbers
  • Deceased or retired doctors
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The article states, “Most health plans had inaccurate information for between 30 to 60 percent of their providers’ offices.” Although these deficiencies could have been remedied if providers were more stringent in keeping their records up to date, the government argues that it’s up to insurers to do their due diligence and audit their records internally to ensure outdated information is removed, and accurate information is provided to the public.

How can you avoid provider-related penalties?

Possible penalties for those organizations that don’t correct their ways by the deadline of February 6th could include fines, sanctions, marketing cessations, or ceased enrollment periods.

Man-powered updates are no longer enough if you want to ensure you’re providing patients with proper care. Automation will help you keep stiff penalties at bay as you abide by the stringent protocols necessary in the healthcare industry. Modify the way you gather data. Explore new ways to ensure that each provider you list in your directory practices at each location on a regular basis. Implore the powers of technology to help you reach your goals.

If you’re concerned about your healthcare practice’s provider directory, it’s best to consider automating your processes as soon as possible. Errors in medical credentialing and provider enrollment will soon be accompanied by steep penalties from the federal government, and a proactive strategy is always better than a reactive strategy. To ensure your facility is up to date in terms of compliance and patient needs, employ the use of medical software that’s specifically developed for your industry’s unique needs.

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