Inaccurate Provider Data Causes Problems for Patients and Healthcare Providers

By Thomas White | December 16, 2015

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In mid-November 2015, the Centers for Medicare & Medicaid Services (CMS) distributed their 2016 Guidance Letter that calls for health plans to update provider directories on a monthly basis. Unfortunately for patients, at the present time, provider data is required to be updated only on a quarterly basis – leaving patients with provider data that is up to three months old when they need to seek healthcare.  

The CMS regulations were initially put in place because provider directories were found to be woefully inaccurate – with many patients reporting unexpected out-of-network fees after their provider was incorrectly listed as in-network. Beginning Jan. 1, 2016, health plans will face fines of $25,000 per beneficiary for incorrect listings.

There is no excuse – today – for any health plan or healthcare organization to be using out-of-date provider information. Affordable technology is available right now that will keep every health plan’s provider directory up-to-date and accurate in real time. This technology will also maintain the same provider data accuracy, enterprise-wide, for any healthcare organization.

Phynd Technologies, Inc. offers a comprehensive Unified Provider Management (UPM) platform that gathers and validates the latest provider data from multiple sources (internal and external), and then integrates the data into a physician directory or a healthcare organization’s disparate legacy systems where physician data resides, allowing this information to be shared with patients seeking healthcare or all of a healthcare organization’s appropriate end-users.

Integration of the UPM allows health plans and healthcare providers to manage and share a single verified, custom profile on each of their physicians. This unified management of physician data provides a single source of truth and allows for accurate provider data reporting in physician directories and within all departments of a healthcare organization.

The UPM platform also provides an ongoing process for sustaining the accuracy of provider data over time, establishing confidence in the quality of the physician data.

Why opt for a monthly update when you can have your provider data reported in real time?


 

Topics: provider, unified provider management, Inaccurate, unified provider management platform, Big Data, new provider, Inaccurate Provider Data, provider database, CMS, upm, Updated Provider Data, Centers for Medicare & Medicaid Services (CMS), physician directory, database, CMS Regulations, 2016 Guidance Letter

Thomas White

Written by Thomas White

Before founding Phynd, Tom co-founded Newscast Inc. and Vocada, Inc. With over 20 years of leadership experience, Tom has applied his knowledge in building software companies and creating new software categories from idea to large market share. He also serves as a mentor to the start-up accelerator Health Wildcatters.

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