Insurance companies could face penalty payments for not correcting physician directories, according to a report in The Wall Street Journal.
Here are five key notes:
1. New regulations will allow CMS to fine insurance companies up to $25,000 per beneficiary if there are errors in the Medicare Advantage plan directories.
2. The fine for errors in plans sold on the federal exchanges will be $100 per beneficiary.
3. States may also impose their own rules and sanctions for insurance companies with outdated provider registries. For example, California fined Anthem Blue Cross $250,000 and Blue Shield of California $350,000 when it was found more than a quarter of the physicians on their directories didn't have accurate location information or didn't accept those plans.
4. There are consumers taking legal action in some states, including California, for the misinformation because patients are stuck with the out-of-network bills when their providers don't accept Medicare plans.
5. Insurers reportedly leave it up to providers to tell patients they don't accept the patients' insurance plans and advise members to ask their physician instead of relying on directories. Errors are common, especially among narrow-network plans excluding some local providers.