---
title: "MedPAC Examines Directory Inaccuracies in Medicare Advantage Plans"
id: "news-news-medical-economics-e0bf0f170e1cdb2b0f5cdae1"
canonical_url: "https://medichelpline.com/news/news-news-medical-economics-e0bf0f170e1cdb2b0f5cdae1"
content_type: "medical_news_article"
category: "Public Health"
source_name: "Medical Economics"
source_url: "https://www.medicaleconomics.com/view/connecting-doctors-patients-and-payers-medpac-digs-into-ma-physician-networks"
published_at: "2026-10-12T19:42:08.000Z"
license: "CC-BY-NC-4.0 / Informational Use"
---
# MedPAC Examines Directory Inaccuracies in Medicare Advantage Plans
## Metadata & Source Attribution
- **Canonical URL:** https://medichelpline.com/news/news-news-medical-economics-e0bf0f170e1cdb2b0f5cdae1
- **Category:** [Public Health](https://medichelpline.com/news/public-health.md)
- **Reporting Source:** Medical Economics
- **Original Source URL:** [Read Original Article](https://www.medicaleconomics.com/view/connecting-doctors-patients-and-payers-medpac-digs-into-ma-physician-networks)
- **Published At:** 2026-10-12T19:42:08.000Z
## Executive Summary & Key Highlights
- Nearly 20% of visits involve doctors not listed in patients' Medicare Advantage directories. - MedPAC meetings discussed discrepancies and potential impacts on care. - Some commissioners urged for more accurate directory maintenance while others caution against over-emphasizing inaccuracies. - The analysis shows high physician participation rates but notable gaps remain in directory listings. - Reliance on primary care physicians and the impact of shifting networks were key discussion points.
## In-Depth Reporting & Editorial Analysis
## MedPAC's Analysis of Medicare Advantage Physician Networks In recent discussions by the Medicare Payment Advisory Commission (**MedPAC**), a pressing issue emerged regarding the **accuracy of physician directories** in Medicare Advantage (**MA**) plans. A federal analysis using 2023 data revealed that almost **one in five** visits to a primary care physician in these plans involved doctors who weren’t listed in the patient's own network directory. The MedPAC meeting aimed to clarify the implications of this mismatch on both patients and physicians. ### Divergent Views on Inaccuracies Members of MedPAC displayed differing opinions on the **directory inaccuracies**. Some commissioners argued that such discrepancies indicate a significant **error rate** that must be addressed by health plans. On the other hand, several members cautioned against viewing these inaccuracies as outright barriers to care. During this month’s presentation, which was led by MedPAC Chair Amol S. Navathe, M.D., Ph.D., staff emphasized the need for accurate directories, noting that MA plans are required to maintain these listings to manage care effectively and ensure that beneficiaries have choices among providers. Katelyn R. Smalley, Ph.D., M.Sc., senior analyst, and Krista Cherry, senior research assistant, highlighted the complexities of provider directories. While **93% of primary care physicians** and **88% of specialists** were found in at least one MA plan’s directory, the encounter data—records submitted by plans for services rendered—indicated even higher participation rates of **97%** for primary care and **98%** for specialists. A closer examination revealed that **9.4%** of these physicians had treated MA enrollees without being listed in any directory. ### The Role of Encounter Data The analysis focused on **HMO** and **PPO** plans exclusively, underscoring the importance of encounter data in assessing network participation rates. Notably, findings indicated that as of February 2023, **32%** of encounters involved physicians not included in the enrollees’ directories, with **18%** being primary care visits and starkly higher mismatches for specialists, particularly in fields like psychiatry and emergency medicine. Commissioners debated whether these inaccuracies stem from outdated information or reflect patients seeking out-of-network care. Evidence suggests that a significant portion of MA claims—estimated between **15% and 22%**—may involve out-of-network providers. This reliance on up-to-date information creates additional challenges, as physicians must relay directory corrections to each plan, often without sufficient motivation to do so. ### Implications for Patients and Physicians The MedPAC discussions highlighted a crucial aspect of patient choice and physician-patient coordination, particularly in primary care settings. Commissioner Joshua Liao, M.D., M.Sc., emphasized that the choices patients make regarding their primary care physicians greatly impact their overall care trajectory. Despite the reported inaccuracies, many acknowledged this specific mismatch was important yet challenging to attribute to a single cause. Responses from commissioners varied. Some advocated for continued scrutiny of how **directory inaccuracies** could hinder access to care and sought increased accountability from MA plans. Others pointed out the necessity of maintaining a balance between overseeing access to care and recognizing the value that managed care brings to health systems. ### The Need for Improved Data Practices While auditing the state of physician directories, commissioners acknowledged that maintaining accurate listings is a complicated endeavor, especially for hospital-based physicians, who may have high turnover or work in temporary positions. Furthermore, advancements in **technology and artificial intelligence** were discussed as potential solutions for improving the timeliness and accuracy of provider listings. Some members, including Commissioner Thomas Diller, M.D., M.M.M., urged for comprehensive changes that keep up with the dynamics of healthcare delivery. They suggested using centralized systems for directory data and leveraging technology to enhance tracking of network changes, thereby preventing unexpected out-of-network encounters that lead to significant patient costs and surprise billing experiences. ### Future Directions and Considerations As discussions continue around the implications of these findings, there remains a continual push for MedPAC to gain better insights into the consistency and accuracy of network status across plans. The mission is not only to guide improvements in directory management but also to ensure that patients can navigate their healthcare choices effectively without frustrating barriers. The interplay between directory accuracy, patient choice, and physician coordination will be pivotal as Medicare continues evolving to address beneficiary needs. MedPAC acknowledges that while some discrepancies may be inherent due to healthcare complexities, ongoing dialogue and investigation will be crucial in ensuring quality care access for all Medicare beneficiaries.
## Navigation
- [← Back to Public Health News](https://medichelpline.com/news/public-health.md)
- [← All Medical News Categories](https://medichelpline.com/news.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.