Since its creation, the Centers for Medicare and Medicaid Services (CMS) have taken great strides to improve access to care for patients while reducing clinical burdens for practices everywhere. As part of this effort, the CMS has announced plans to implement a National Provider Directory designed to provide a central, streamlined archive of accurate information for all providers nationwide. Before this, provider directories were usually monitored by individual health plans, resulting in numerous directories across the country. 

This new national directory aims to make gaining access to crucial information easier. Back in October 2022, CMS Administrator Chiquita Brooks-LaSure released a Request for Information seeking public input on the new initiative, saying, “Easy access to accurate and useful provider directory information is critical for patients trying to find healthcare that best meets their individualized needs.” 

But as this national directory edges closer and closer to fruition, what will it mean for your practice? 

CMS plans for this new directory to act as a centralized data hub for healthcare providers, facilities, and entity directory information across the country. This directory will also connect to the No Surprises Act, which requires directories to be accurate, updated, and verified every three months. In this post, we’ll dive further into the goals and objectives of this newly proposed National Provider Directory and how it will affect your practice. 

      National Provider Directory Enhances Access to Electronic Healthcare Information Exchange 

      A prominent problem in the industry that arose during the Covid-19 virus was the ability to easily access information from the electronic healthcare information exchange (HIE). As the name suggests, this database allows physicians to access and securely share a patient’s medical information electronically, thus improving the speed, quality, and cost of patient care. During the pandemic, practices had trouble accessing the HIE for critical data, showing a decrease in patient quality. 

      As part of the National Provider Directory, the CMS hopes to improve data exchange by utilizing interoperable technology. This would include using different systems over various platforms to connect and communicate with physicians in a coordinated way. Now, patients will be able to look up and see what providers are available in their network for their specific region and insurance plan. In addition, consumers will be able to utilize this system instead of using their health insurance plan as a middleman. 

      The implementation of the National Provider Directory also plans to enhance access to the HIE in hopes of allowing more physicians access to sharing vital patient information to inform better decision-making. The act also hopes to help in the following: 

      • Eliminating readmissions 
      • Cutting medication errors 
      • Improving diagnosis and patient 
      • Reduce duplicate testing 

      No Surprises Act 

      On January 1st, 2022, Congress passed the No Surprises Act as part of the Consolidated Appropriations Act of 2021. The passing was designed to shield patients from any surprise bills for emergency services for out-of-network facilities. This also applies to out-of-network providers at in-network facilities, ultimately holding them accountable for in-network cost amounts. In addition to these factors, the act also allows uninsured patients stable estimates for the cost of care. 

      The proposed National Provider Directory would work copacetic with the No Surprises Act, as one of the requirements for the act is to have accurate directories that are updated every three months. While this shared goal will be a massive undertaking for all involved, the CMS has volunteered to build this directory by underwriting the technical lift. This would result in the providers being responsible for updating their own data. 

      In the past, providers have had extensive issues performing timely updates for their information. This often results in data being misplaced and care being delayed. Along with the No Surprises Act, the National Provider Directory aims to establish a single source of reliable information that will provide updates and data without delay. 

      The National Provider Directory Will Work as a Central Hub

      Another goal the CMS has for the National Provider Directory is to establish it as a centralized hub of accurate and up-to-date information centered around providers. This would enhance the process of exchanging electronic medical data, benefiting patients with a single source of information about the best healthcare options to fit their needs and expectations. 

      With this central hub, the CMS hopes to mend the fragmented healthcare directory outlook. By bringing all of this information together to one central platform, providers can exchange medical data efficiently and promptly without a loss in quality or accuracy. 

      National Provider Directory Wrapped-Up 

      There’s no doubt that the CMS’ plans for the National Provider Directory are audacious. But with the proper work and patience, this central directory could prove to be a big game changer for PALTC practices everywhere. Not only will this director provide easy access to the electronic healthcare information exchange, but it will also ensure that this information is accurate, updated, and verified every three months, akin to the No Promises Act. In addition to this providing reliable data, the National Provider Directory will also serve as a centralized hub for patients nationwide to examine healthcare providers within their network. This directory will require a lot of time and work, but the CMS is once again dedicated to seeing this dream project become a reality.

      For further information, check out our blog page for future updates. 

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