An official website of the United States Government —

Here’s how you know

Official websites use .gov

A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Advising the Congress on Medicare issues
MedPAC > Recommendations > Ensuring the accuracy and completeness of Medicare Advantage encounter data

Ensuring the accuracy and completeness of Medicare Advantage encounter data

June 14, 2019

The Congress should direct the Secretary to establish thresholds for the completeness and accuracy of Medicare Advantage (MA) encounter data and:

  • rigorously evaluate MA organizations’ submitted data and provide robust feedback;
  • concurrently apply a payment withhold and provide refunds to MA organizations that meet thresholds; and
  • institute a mechanism for direct submission of provider claims to Medicare Administrative Contractors
  • as a voluntary option for all MA organizations that prefer this method
  • starting in 2024, for MA organizations that fail to meet thresholds or for all MA organizations if program-wide thresholds are not achieved.

Topics: Part C (Medicare Advantage).