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Blog Posts by Tag: Molecular

United Healthcare Reimbursement Policy Update for Molecular Pathology

United Healthcare announced that the effective date of their reimbursement policy update for molecular pathology has moved from dates of service beginning September 1, 2019, to dates of service beginning November 1, 2019.This reimbursement policy change affects claims submitted with codes for Tier 1 and Tier 2 Molecular Pathology. Tier 2 Molecular Pathology codes are 81400 – 81408, and are to be...


Integrating Laboratory and Clinical Data: A Framework for Improving Reimbursement of Genomic Testing

IntroductionIn 2017, there were roughly 75,000 genetic tests on the market with about ten new tests added daily.1 The rapid expansion of genomic testing, particularly next-generation sequencing (NGS) panels, has led to uncertainty about their appropriate use, interpretation, and clinical utility. Indefinite clinical utility leads to claims denials which are appealed through a lengthy...


Hidden Landmines in Revenue Cycle Management: Industry Challenges, Patient Engagement, and Denial Trends (Part 1)

This is the first post of a three-part blog series focused on key areas of business performance management for pathology practices, hospital outreach programs, diagnostic laboratories, and molecular diagnostic providers. The other blog posts in this series can be found here:  Part 2 and Part 3 A number of trends in payor behaviors and...


Improve Reimbursement for Genomic Tests by Leveraging Real World Data

Since the sequencing of the human genome in 2003, genomic testing has become the fastest growing category of biomarker testing within the diagnostic laboratory industry. Many laboratory developed genomic tests use next-generation sequencing (NGS) as an approach to target numerous genomic variants with both proven and emerging evidence of clinical utility. While the panel approach is forward-...


What You Need to Know About the Changing Landscape and the Impact to How Labs Must Submit Claims to Enable Reimbursements

Prior authorization in the medical field is a necessary but flawed process that causes challenges for physicians as well as everyone involved from submission to approval. For those who are unaware, prior authorization is a requirement that a physician obtains approval from a patients health insurance plan to prescribe a specific medication or lab test. Prior authorization is a technique...


How to Prepare Your Lab for Next-Gen Sequencing and Big Data Science

Industry experts estimate that anywhere between 100 million to 2 billion genomes will be sequenced by 2025. With the growing demand for next-generation sequencing (NGS), from bases to whole genomes, and the growing demand for sequence-based drug discovery applications and diagnostic testing, there’s no denying that labs will need to accommodate a huge amount of data very soon.What does genomics...