Back in December of 2010, CMS launched a new web site called Physician Compare. The site is specifically designed to provide consumers with information to help them identify and locate a Medicare enrolled provider in their geographic area. The consumer goes to the web site, enters the type and gender of provider he or she is seeking, his or her zip code and whether or not they are looking for participating or non-participating provider. The site then generates a list arranged by distance from consumers location. Information provided includes the physician’s name, address, phone number, distance from consumers location, language capabilities and Medicare participation status (ie participating/non participating)

However it appears that a number of physicians have found that the information contained on their record is incorrect. The common errors include:

• Name misspellings

• Incorrect Medicare participation status

• Inconsistent results derived from location-based searches

• Listings include doctors who no longer practice.

The Information contained on the Physician Compare site are derived from the Medicare Provider Enrollment, Chain and Ownership System (PECOS), so any information that is missing or incorrect on that file will likely transfer to the Physician Compare web site.

A couple of obvious issues here:

• If you haven’t taken a look at the Physician Compare site and checked the information…do so.

• If the information on the Physician Compare is incorrect go to your PECOS record and change it. While your there check all the other information on the record to make sure it’s correct and up-to-date.

• Even if the Physician Compare information is correct, if you haven’t updated your PECOS record in the last 5 years, it’s a good idea to access it anyway and check all the info. CMS will continue to use this record as the definitive source document for any and all current and future data bases.

If you do uncover a problem, CMS provides some additional guidance to help fix errors in the listings, see http://www.medicare.gov/find-a-doctor/staticpages/note/overview.aspx

For doctors who are properly enrolled in Medicare (in the PECOS database) yet unlisted on the Physician Compare website, compare the information on PECOS to your listing in the NPI registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do and correct any inconsistencies. If none are found then send your name, NPI, and city/state location to Rodney Peele in the AOA Washington Office at rpeele@aoa.org.

CMS has pledged to try to fix the flaws in the mapping software and to investigate the reason why many doctors remain unlisted in their geographic location.

The Physician Compare web site is just the first step in CMS’s overall plan to provide the Medicare consumer and consumers in general with more information about healthcare providers. Next up are quality measures, sure to ruffle some feathers. However at this early stage it’s key that an enrolled provider basic information is correct and up to date.

A key provision of the Affordable Care Act required that the CMS establish the “Physician Compare” web site. This site contains a file called the “Healthcare Provider Directory” which is designed to serve as a guide for individuals seeking the services of a Medicare participating physician or other medical professional. To be eligible for inclusion in the Directory a medical professional must undergo the provider enrollment process and participate in the Physician Quality Reporting Initiative/System.

The “Healthcare Provider Directory” offers a searchable data base containing information on qualified healthcare providers by: type of profession, specialty, geographic location, gender, languages spoken, education and hospital affiliations. It also indicates whether or not the provider participates in Medicare. The patient inputs the specialty he/she is interested and their home ZIP code. A list of providers is generated arraigned by distance from the home ZIP code.

The CMS has decided to based the “Healthcare Provider Directory” largely on information gleaned from the Provider Enrollment, Chair, Ownership System (PECOS). Therefore to have a record appear in the file, providers must have an active record in PECOS. If a provider doesn’t he/she will not appear in the Directory. In addition to having an active record, it’s also important that the record be accurate and kept current to insure the information is being supplied to those using the system is in fact correct.

As has been reported in many outlets, the current CMS push for PECOS registrations has encountered some difficulties, with system overloads, delays and backlogs often the result. As evidence of these problems, the CMS has postponed the threatened billing edits, refusing payments if referring providers are not resisted on PECOS, several time over the past year. They have have yet to fix a hard and fast date when they will begin, again attesting to some ongoing issues. The AAFP itself has expressed concern in this regard and has sent the CMS a letter pointing out the problems encountered with PECOS’s accuracy and currency and requested that the Directory be updated frequently to reflect new and more accurate data.

Many Medicare patients are expected to take advantage of the new Directory, helping them identify appropriate physicians and other healthcare providers. Given the ongoing enrollment delays and accuracy issues it’s important that, if not not currently enrolled, providers begin the process immediately. Once the provider enrollment process has been completed, it’s important to check the Healthcare Provider Directory for accuracy. And lastly it’s important to make sure that someone within a practice or group is charged with the responsibility of keeping the PECOS record current and up to date.