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Webinar: State of the Genetic Testing Marketplace–Getting Paid for All Your Lab’s Genetic Test Claims: What’s Changing, What’s Not, and What’s Working Best

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State of the Genetic Testing Marketplace–Getting Paid for All Your Lab’s Genetic
Test Claims: What’s Changing, What’s Not, and What’s Working Best

Getting paid for genetic test claims continues to be the single biggest challenge for all clinical laboratories and
anatomic pathology groups. In response to the substantial surge in the numbers of new genetic tests—many of which cost
thousands of dollars per test—payers are placing tougher restrictions how they accept and pay for genetic test claims.

The good news is that there are pathways forward that savvy genetic testing executives can use to accomplish three
different objectives—each of which can increase cash flow and lift the number of genetic test claims
that are reimbursed. They are:

1. Obtaining a successful coverage decision for your lab’s genetic test by understanding how to meet a payer’s coverage
criteria

2. Working with individual health plans so that your genetic testing lab becomes an in-network provider

3. Submitting a higher proportion of “clean” genetic test claims that the payer reimburses on first submission because
your laboratory created appropriate workflows with referring physicians to both meet any prior-authorization requirement
and to get the proper documentation from the physician that supports medical necessity and other payer requirements

Every clinical laboratory and genetic test company can use these 3 approaches to significantly increase net collected
revenue and reduce denials, but only if the coding, billing, and collections team understands the current state of
genetic testing in the United States and how that is driving payer actions to manage utilization of genetic test claims.

DARK Daily hosted a live webinar featuring three experts in genetic testing titled, “State of the Genetic Testing
Marketplace-Getting Paid for All Your Lab’s Genetic Test Claims: What’s Changing, What’s Not, and What’s Working Best,”
that was followed by a panel discussion, allowing attendees to interact with the experts in real-time, to ask questions
about their topics of greatest interest.

During this 90-minute webinar, participants can expect to:

Learn why payers must now deal with more
than 5,000 new genetic tests launching every month and how that complicates claims processing
Understand how the variation in CPT
coding by different genetic testing labs complicates claims processing by payers
Explore the challenges and opportunities
to help payers apply their medical policies to genetic test claims
Understand why “benefit investigation” is
already a huge factor as consumers seek the lab with the cheapest genetic test price before they agree to be tested
Master the art of working with
prior-authorization programs and know why having documents prior to authorization still does not mean the payer will
reimburse for that genetic test claim
Compare different tactics when payers
audit genetic test claims and learn the right way to respond to documentation for medical necessity
Assess Medicare’s policy changes at the
national level for genetic tests
Know the core elements of the Medicare
MolDx program that governs genetic test claims across 28 states
Distinguish how the federal government’s
Operation Double Helix cracked down on billions of dollars of fraudulent use of genetic tests
Use the Operation Double Helix court
documents as the road map to identify the genetic tests and CPT codes that federal prosecutors use to guide their
enforcement of the Anti-Kickback Statute, the Stark Law, and EKRA