Are Medicare Advantage Plans Unfairly Denying Radiotherapy?

Medscape December 5, 2024
Edited by Gargi Mukherjee

TOPLINE:

Medicare Advantage plans are inappropriately denying radiation therapy services significantly more frequently than other health services, new data show.

METHODOLOGY:

• Medicare Advantage plans are expected to cover all services that Traditional Medicare covers (outside of hospice care). Radiotherapy services for cancer are included in Medicare Advantage plan coverage.
• In the current study, researchers aimed to assess whether radiotherapy services are being inappropriately denied more or less often than other medical services.
• The researchers extracted data that contained appeal decisions from the Centers for Medicare & Medicaid Services website between 2022 through June 2024, focusing on decisions by an Independent Review Entity, which determines the appropriateness of a denial based on Medicare guidelines.
• The analysis involved 1576 radiation therapy...

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