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Navigating the Shifting Landscape of Genetic Testing: Insights from XiFin’s LVI
May 7, 2024
Looking back on the first quarter of 2024, XiFin’s Laboratory Volume Index yields further evidence of a trend that has been observed since the onset of COVID: molecular and genetic testing are on a continued growth curve. Let’s explore the latest developments and their implications for laboratories and healthcare providers.
The Rise of Molecular and Genetic Testing
Since the peak of the pandemic, molecular and genetic testing has witnessed remarkable growth. While other testing areas have stabilized around pre-pandemic levels, molecular and genetic testing continues to soar, fueled by advancements in technology and increasing clinical relevance.
Navigating the Payor Landscape
Alongside this growth comes heightened payor scrutiny and cost-control measures. Payors have been particularly active in implementing policies to manage costs associated with genetic testing. It’s imperative for laboratories and healthcare providers to stay abreast of these developments to ensure optimal patient care and financial sustainability.
RECENT KEY EVENTS
A sampling of recent events and updates underscore the dynamic nature of the payor landscape:
- UHC’s delayed commercial implementation of Z-codes to June 1, 2024
- Indiana legislature’s mandate for biomarker testing coverage
- Revised coding rules for molecular testing panels
- Changes in prior authorization requirements for Anthem Medicare Advantage programs
- Revisions to UHC’s coverage policies for whole exome and whole genome sequencing
Adopting Strategies for Success
In light of these developments, laboratories performing genetic testing will find they need an inter-departmental strategy to optimize performance. Alignment between RCM, Market Access, Client Service, and Finance teams is crucial for navigating the complex prior authorization process and optimizing outcomes. A high success rate in obtaining prior authorizations will help as Gold Card programs gain traction, and partnering with genetic counselors or similar experts who can review documentation before requesting authorization can contribute to success, as does educating referral sources on policies and documentation requirements.
Looking Ahead
As the landscape of genetic testing continues to evolve, staying informed and adaptable is paramount. XiFin’s Billing Beat newsletter offers invaluable insights into the latest trends and policy changes, empowering laboratories and healthcare providers to navigate the ever-changing terrain of genetic testing with confidence.
With greater scrutiny and cost-control measures for genetic tests, laboratories need an inter-departmental approach that aligns strategy across the organization, up-to-date information on the payor landscape, and a commitment to adopting proactive strategies. Embracing collaboration and staying informed are keys to success in this dynamic field.
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