According to a survey released today by the American Medical Association (AMA) and LexisNexis® Risk Solutions, more than half of U.S. physicians (52 percent) say they encounter patients every month with health insurance coverage issues due to inaccurate directories of in-network physicians. The survey findings illustrate a need for physicians and health plans to work together to help eliminate potential barriers to care when patients rely on outdated, inaccurate or incomplete directory data to locate an in-network physician.
The new findings, which examined the experiences of roughly 700 U.S. physicians, underscore that network directories are a critical tool for patients when making decisions about their health care. The vast majority of physicians (89 percent) say it is important to be accurately represented in network directories. Patients who make decisions based on inaccurate directories risk incurring unnecessary costs when they thought they were using an in-network physician.
The new survey comes on the heels of a federal audit of network directories published by Medicare Advantage plans, which found that 52 percent of the provider locations listed had at least one inaccuracy. As a result, the federal officials issued 23 notices of noncompliance and 31 warning letters this year to Medicare Advantage plans.
"Recognizing the importance to patients of high quality directories, federal and state governments have created regulations requiring health plans to increase the frequency of physician data verification," said Laurie McGraw, senior vice president of AMA Health Solutions. "As a consequence, some physician offices have experienced an increase in repetitious data verification requests from health plans that are mandated to constantly ensure the quality of network directories."
The duplication and complexity of data collection has left some physicians inconvenienced by an administrative burden. Yet most physicians (79 percent) are unaware that health plans are responding to mandates that require regular data verification. In fact, about two-thirds of physicians (67 percent) would prefer a single, centralized interface that can simultaneously update directory information with multiple health plans.
"Ensuring the accuracy of network directories needs to be a truly collaborative process for physicians and health plans," said McGraw. "Physicians want patients to make informed health care choices, while health plans seek to comply with mandates to publish the most up-to-date network directories."
The survey of physicians was released by the AMA and LexisNexis as part of a collaboration that offers physicians and health plans a centralized solution, VerifyHCP ™, which delivers data to facilitate meeting state and federal directory mandates.
Jointly launched in March 2017, VerifyHCP is powered by the physician resources of the AMA and its wholly-owned subsidiary AMA Business Solutions, along with LexisNexis analytic technology and the LexisNexis® Provider Data MasterFile™ to enable simpler and more efficient data confirmation to help create more accurate network directories and most importantly, supports the needs of patients, physicians and health plans.
"We knew there had to be a better, more efficient way for physicians and their office managers to simultaneously update practice details for multiple health plans," said Josh Schoeller, vice president, Client Engagement, LexisNexis Risk Solutions. "The solution was in the data. LexisNexis houses one of the most comprehensive provider databases and, in combination with the AMA's extensive relationships with physicians and practices, we developed a solution that uses a single sign-on and has the ability to pre-fill, collect, monitor, cleanse and update data in an easy-to-use, efficient manner."
VerifyHCP makes it unnecessary for health plans to send physicians duplicative data verification requests, relieving physicians of the distraction from a barrage of uncoordinated requests from multiple health plans. VerifyHCP enables medical practices to validate or update directory information through one channel for all participating health plans.
VerifyHCP is a uniquely flexible solution to update practice details for multiple health plans, reducing costly administrative tasks for medical practices and health plans. At the same time, it streamlines compliance with network directory accuracy requirements for health plans and helps ensure patients know which of their physicians participate in their current health plans.
For additional information, please visit the LexisNexis website.