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 processingUnderstand how the variation in CPT coding by different genetic testing labs complicates claims processing by payersExplore the challenges and opportunities to help payers apply their medical policies to genetic test claimsUnderstand why “benefit investigation” is already a huge factor as consumers seek the lab with the cheapest genetic test price before they agree to be testedMaster 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 claimCompare different tactics when payers audit genetic test claims and learn the right way to respond to documentation for medical necessityAssess Medicare’s policy changes at the national level for genetic testsKnow the core elements of the Medicare MolDx program that governs genetic test claims across 28 statesDistinguish 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
President & Editor in Chief
The Dark Intelligence Group