At the practice level, accurate data is imperative for appropriate patient treatment plans and for reimbursement purposes. When data is not accurate, mistakes can be made. Accurate data is also important at the administrative level, when efforts are made to track provider information to ensure records are current.
The Council for Affordable Quality Healthcare (CAQH) has launched an initiative that will involve an alliance with organizations such as the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) in an effort to improve the accuracy of provider data. The Provider Data Action Alliance initiative will benefit these administrative bodies as well as the physicians and their patients.
The healthcare industry invests more than $2 billion annually to maintain physician data; however, a report released earlier this year by the Centers for Medicare & Medicaid Services “found that 45.1 percent of practice locations listed in on-line provider directories were incorrect.” Inaccurate data can lead to significant issues in billing and paying claims as well as with generating provider directories. For example, patients who need to communicate with physicians may find that they have moved or retired even though they are still listed as active providers.
The Provider Data Action Alliance has identified the need to increase provider engagement in the data maintenance process as another key issue and focus of their initiative. Maintaining accurate data can be time-consuming, particularly if an independent physician needs to notify multiple providers, healthcare facilities, and healthcare plans. Such updates can become an administrative burden added to their everyday practice management tasks. Regulations regarding data updates can also vary from state to state.
Throughout the effort, throughout the summer of 2017, the Provider Data Action Alliance plans to “explore how best to develop industry-accepted data definitions, improve maintenance processes and accountability measures, centralize data resources and foster greater regulatory alignment.”