Medicare Advantage Plan Provider Directories

Physicians, Take Note: 2016 Could Bring CMS Contractor Call

December 01, 2015 03:26 pm News Staff

Heads up to family physicians who serve patients covered by Medicare Advantage plans: Come 2016, your staff may receive a phone call from a CMS contractor to verify your practice's information in a particular plan's provider directory.

[Female picking up office phone]

CMS recently announced that it has contracted with business management consultant Booz Allen Hamilton to assist in the monitoring effort.

According to an email from CMS' Office of Communications, the agency has formulated a procedure to alleviate confusion and to proactively verify the authenticity of calls. The Booz Allen Hamilton caller will, at the beginning of each telephone conversation, advise the physician's office staff member taking the call that the consultant is calling on behalf of CMS.

CMS also clarified in the email correspondence why it was making the effort.

"Medicare Advantage enrollees rely on accurate and up-to-date provider directories to help them make educated decisions about their plan choices," said CMS.

Confirming Details

After receiving the correspondence from CMS, an astute AAFP staff member followed up with questions of his own. Here are some of those queries and CMS' responses:

Story Highlights
  • CMS has charged a contractor with making phone calls to random physician practices to verify their information in Medicare Advantage plan provider directories.
  • Callers will begin their work in January, will take less than five minutes per call and will not ask practices for sensitive patient information.
  • The AAFP has long demanded that CMS work to standardize and simplify plan directories because they provide critical physician information to Medicare Advantage beneficiaries.

Q. How many calls per month will be made to practices?

A. This effort will be nationwide, and the number of calls will vary.

Q. How long should each conversation take?

A. The estimated length of the phone call is less than five minutes.

Q. Who will the caller ask for to get the necessary information?

A. The Booz Allen Hamilton caller will speak with the staff member who answers the phone and will ask to be transferred if that person is unable to provide the requested information.

Q. Will this effort be an ongoing process, or is there an end date to collect information?

A. The monitoring effort will start at the beginning of the year and will continue as necessary.

Q. Is CMS concerned about fraudsters claiming they are from CMS and collecting sensitive information from practices?

A. CMS takes fraud very seriously. Your members should be aware that we are not requesting sensitive information as part of our provider directory monitoring calls and that all information verified in this effort is within the public domain. Moreover, if there is any question about the authenticity of the calls, the caller will provide proof -- upon request -- that this is indeed a legitimate call on CMS' behalf.

Q. Did CMS consider using existing trusted contractors such as MACs (Medicare administrative contractors)?

A. CMS follows standard policy and procedure to procure contractors, including the contractor to assist in this monitoring effort.

Q. Our physician members contract with many Medicare Advantage plans. Will the calls seek to aggregate responses for all plans in a given geographic area, or will practices get separate calls for each plan?

A. The call seeks to validate the information found for the health care professional in a particular Medicare Advantage organization's provider directory. There is a random aspect to the way that the calls will be conducted. As such, while possible, it is unlikely that a physician would be called more than once.

AAFP Advocacy Efforts

For its part, the Academy leadership has been relentless in demanding that CMS work to standardize and simplify such directories.

In a March 5 letter to CMS, (then) AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., noted that valid provider directories were critical to addressing accessibility issues for Medicare Advantage beneficiaries.

And in a Sept. 28 letter to CMS, Blackwelder again acknowledged the critical need for up-to-date directories, but pushed back hard against CMS' plan to update such directories every 30 days, citing the administrative burden it would place on busy physicians.

He noted that physicians could receive as many as 90 such requests a year; Blackwelder suggested a 90-day reporting interval instead.

Related AAFP News Coverage
Letter to CMS
Guard Against Narrow Networks in Medicare Advantage Plans, Says AAFP