If you want to pass a provider directory audit, looking at your provider outreach analytics is a great place to start. With the right analytics, you can demonstrate compliance and improve provider data accuracy. In this article, we’ll walk you through the must-have metrics to help you stay on the right side of compliance and safeguard your organization during audits.
Changing Provider Directory Accuracy Requirements: What You Need to Know
The requirements for provider directory accuracy continue to change. Federal and state requirements have tightened like never before. Here are a few of the most significant changes.
Rolling 90-Day Basis: Some federal and state-level regulations now mandate that healthcare organizations regularly update and verify their provider directory information on a rolling 90-day basis, rather than on an annual basis.
Tighter Turnaround Timelines: New regulations specify turnaround times of 2 days and 5 days for updating directory information on websites and promptly informing patients about network changes.
Increased Data Elements to Verify: In addition to basic provider information, cultural-linguistic data, such as languages spoken, must now be validated within health plan provider directories.
Transition to 90-Day Data Audits: Certain agencies and organizations conducting data audits are changing their timeframe to align with the regulations, requiring provider outreach activities to be reviewed within 90 days instead of 6- or 12-month periods.
Tip: Discover more ways to improve your provider data accuracy strategy. Check out our article: 5 Best Practices for Improving Provider Data Accuracy, Provider Outreach, and Outcomes.
Enhancing Transparency with Your Provider Outreach and Verification Efforts
Pass your provider directory audits with flying colors by capturing the right data. Steve Slaton, VP of Product Management at Quest Analytics shares which provider outreach and verification metrics to track. Plus, find out why summary and detailed metrics are key to compliance.
Data Transparency: Equipping Your Organization for Provider Directory Audits
With these new requirements in mind, it’s important to have transparency in your provider outreach and verification activities. It’s all about being open and showing every step and action you take to confirm provider data. Why? Well, it helps you demonstrate compliance and keep your internal stakeholders in the loop.
Now, let’s talk about the metrics that matter: summary and detailed metrics.
Summary Metrics: The Big-Picture View of Outreach Activities
Summary metrics give you a big-picture view of your provider outreach efforts. Steve Slaton, our Vice President of Product Management, says the main goal of these metrics is to provide you with a quick snapshot of your outreach progress at any time. To start, we recommend having the following three views of your provider outreach activities.
- Practitioners at Service Location Outreach Metrics
- Practitioner Outreach Metrics
- Service Location Outreach Metrics
Pro Tip: Make sure your data analytics can show you which providers you can’t reach out to. It’s important to know who’s in your data but not reachable. And guess what? Quest Enterprise Services™ Accuracy can help you with that. Learn more about how they can make it happen!
Now, let’s break it down further. For each category, your summary outreach analytics should give you insights like the following.
Example: We’re diving into the data for our “Practitioners at Service Location Outreach Metrics”. Here’s what you’ll want to look at:
- The Number of Total Practitioners at Service Locations
- The Number of Outreachable* Practitioners at Service Locations
- The Number of Not-Outreachable* Practitioners at Service Locations
- The Number of Outreach Attempts in a defined period
- The Number of Outreach Completions in a defined period
*When we talk about “outreachable,” we’re referring to the percentage of practitioners eligible for outreach out of your total network. And when we say “Not-Outreachable,” it means practitioners who are not eligible for outreach. This could include retired or deceased providers or closed service locations.
Review-ready and compliant-confident are always the way to be! To help you get started on the path to provider directory accuracy, we’ve got a little gift for you: a free provider data accuracy workbook! It’ll guide you through the process and keep you organized. Download it today!
Get Your Free Provider Data Accuracy Workbook
Detailed Metrics: Provider Outreach and Attestations
While summary metrics give you an overview, it’s equally important to have detailed analytics on provider, specialty, and location combinations. Alongside capturing essential details like NPI, Name, Organization, and Address, make sure you track these key elements:
- Outreach Eligibility: Is the provider eligible for outreach?
- Last Outreach Date: When was the last outreach attempted?
- Last Outreach Method: How was the last outreach performed?
- Last Attested Date: When did the provider last respond?
To illustrate, let’s take Dr. Aguilar as an example. By keeping track of the provider’s outreach eligibility, the outreach date, the outreach method, and the last attestation, you’ll have a paper trail of your activities, demonstrating compliance and accountability.
Stay Compliant, Stay Transparent, and Keep Your Provider Data on Point
The evolving landscape of provider directory verification necessitates a sharper focus on compliance. By having provider outreach metrics at the summary and detailed levels, you can enhance transparency in your efforts and steer your activities to meet changing regulatory requirements.
Have the Metrics You Need for Optimal Transparency
When it comes to developing and analyzing meaningful metrics for provider data accuracy and network adequacy compliance, it’s important to partner with experts who specialize in these areas. That’s why partnering with Quest Analytics® is crucial to your success. With our support, you can level up your provider data accuracy strategy and drive positive results. Get started today!
