I think we can all agree that you can’t fix a problem until you know it’s there. Spending time with my healthcare customers confirms the validity of that adage. My customers are facing mounting regulations and exposure to fines because of data inaccuracies they are sometimes not even aware exist. Most health plans and hospitals are ill-equipped to effectively maintain data, including provider directories. Their main focus is to help administer care and benefits to the communities they serve and rightfully so. To help, here are three quick “tests” that healthcare organizations can and should do to better identify the depth and breadth of their data problem:

  1. Do a data quality check. Providers frequently change affiliations, practices, specialties, etc. In just one year, information on healthcare providers can change by as much as 25%.
  2. Check your CMS requirements. From Round 1 to Round 2, the results are the same…the latest CMS directory audit reveals that directories are still in bad shape. With Round 3 in process, and fines slated to roll out in 2019, the time is now for payers to implement end-to-end provider data management strategies.
  3. Scrub your data against a trusted data partner. A data partner greatly reduces the administrative burden on payers and providers. In addition to acquiring and standardizing all the data, it has the ability to:
  • Identify active/inactive practice location and group affiliation.
  • Identify missing locations and missing providers for a contracted group.
  • Separate coverage locations from actual service locations.
  • Address network adequacy by identifying providers with the specialties and geographies where a health plan is short.

Is it a quick fix? No, I firmly believe that all of this information can be extremely useful to health plans and hospitals attempting to service its members as well as keeping up with the competition. The cost of NOT doing it is far greater than what you might imagine.

Want to know more? Listen to our recent webinar, “Total Directory Resolution: Mitigate Directory Accuracy Challenges by Addressing Large and Delegated Groups,” presented by LexisNexis® Health Care and the American Medical Association.