Claim Denials for Cancer-Related Next-Generation Sequencing in Medicare.

ABSTRACT:

Importance

The Centers for Medicare & Medicaid Services implemented a National Coverage Determination (NCD) for genetic testing using next-generation sequencing (NGS) in March 2018 and amended it in January 2020. Little is known about how often NGS insurance claims are denied and what factors are associated with these denials.

Objective

To examine the prevalence of and factors associated with claim denials for NGS testing among Medicare enrollees.

Design, setting, and participants

This cohort study used a 20% random sample of Medicare claims data from January 1, 2016, to December 31, 2021. Statistical analysis took place from June to October 2024.

Main outcomes and measures

Claim denials were measured based on payment and denial data. Multivariable logistic reg

SUBMITTER: Kang SY 

PROVIDER: S-EPMC12008754 | biostudies-literature | 2025 Apr

REPOSITORIES: biostudies-literature