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Claim Denials
Oncology Data Abstraction: Fixing the Denial Rate at Intake, Not on Appeal
Oncologists report denial rates of 30 to 40 percent on claims submitted to commercial payers, high enough that some say they hold their breath every time they submit one (Oncology News Central). A separate review of appealed genetic-testing denials from 2019 to 2023 found 46 percent were overturned on independent review, and cancer accounted for 70 percent of that dataset.
Claim Denials
The Denial Rate Nobody Puts on the Board Deck
The molecular diagnostics denial rate sits at roughly 35.3 percent (XiFin) of billed CPT codes, and prior authorization is the single most frequent reason. That number rarely makes it into a board deck, because by the time anyone’s building the deck, it’s already been absorbed into write-offs, rework, and an appeals team’s monthly numbers. This piece is about what that number actually costs, and why the fix belongs at order intake, not in the appeals queue.