Antibody testing volumes are lower than expected, while lab testing volumes have rebounded since March 2020, according to XIFIN data shared at a recent UBS audio conference. XIFIN’s Executive Chair and CEO Lâle White and Executive VP and General Manager of Diagnostic Services Kyle Fetter were on hand to share updates on nationwide COVID-19 testing and payor behavior.
“COVID-19 has impacted volumes, mix, and reimbursement for a variety of diagnostic providers,” said White. “As we move forward to the next stage of this pandemic, it’s critical that information on the spread of COVID-19 be timely, accurate, and based on science. Until a vaccine or an effective treatment is found, testing is the way we will derive the facts needed to manage the virus and potentially avoid another lockdown. We are seeing confusion surrounding antibody testing that is impacting the availability of crucial data, and the key players involved – physicians, labs, payors, and government – must all work together to educate and steer our complex health system into obtaining this necessary and scientifically-grounded data.”
Since March 2020, XIFIN has performed ongoing analyses of its vast repository of data and publishing weekly updates to its Lab Volume Index. Currently, XIFIN sees 20% to 25% of all COVID-19 and antibody testing claims nationwide. Here are some of the findings shared by XIFIN at the UBS audio conference.
Total Lab Testing Volumes Have rebounded Since March, But Antibody Testing Remains Notably Low
XIFIN’s analysis revealed that COVID-19 started to impact routine testing volumes in March, as states began to shut down and impose stay-at-home orders. Overall routine testing levels were at a low of 45% in April compared to baseline pre-COVID levels, although some laboratory segments saw routine testing fall to as low as 34% of baseline. They have since rebounded to 80% overall, though some segments have stalled to less than 70% of baseline, while others are approaching 90% of baseline.
COVID-19 testing began to have an impact in late March, generating about 10% of the baseline volume. As of June 28th, it had grown to over 50% of baseline volumes, with another 6% attributed to antibody testing. The combination of routine, COVID-19, and antibody testing stood at nearly 140% of baseline overall. Some segments are seeing 160% of baseline volumes, while others are still straining to meet pre-COVID levels, which demonstrates that capacity still exists nationally.
Antibody testing volumes have been significantly lower than anticipated. XIFIN experts expect that these volumes will rise in conjunction with return-to-work activity but said that stronger coverage cooperation from the payor industry is needed.
Payor Response to COVID-19 Adds Stress to Already-Stretched System
XIFIN reported that the payor response to the pandemic has been slow and inconsistent, creating challenges to adequate reimbursement, ongoing testing plans, and back-to-work efforts.
Exceeding $40 billion in gross annual claims billing for hospital-based and independent diagnostic lab RCM customers, XIFIN serves as an intermediary between laboratories and health insurance providers. The company is well-positioned to observe payor behavior when it comes to COVID-related claims. Under the CARES Act, private health plans are required to eliminate co-pays, deductibles, and claim denials for diagnostics and care related to COVID-19.
In March, XIFIN saw that approximately 22% of payors had erroneously denied some portion of COVID-19 PCR testing claims initially. These erroneous denials have since dropped to about 8%. Of those, nearly half will likely be resolved through payor education, which is good news for labs, their patients, and a stressed system. The remaining improperly denied claims—amounting to 4% overall—tend to be from smaller regional insurers and will require appeals efforts to clear.
Antibody testing reimbursement has proven to be a more significant concern. Initially, XIFIN saw payors improperly deny or mis-pay 43% of these claims. After two months, this has decreased to approximately 25%. The bulk of these instances are incorrect reimbursement rates for antibody testing, primarily due to the use of pre-existing CPT codes. Despite Medicare setting a price point for COVID-related antibody tests in the $40s, XIFIN is seeing a median reimbursement rate of $20, with some payors reimbursing as low as $2. Some payors have agreed to review pricing for COVID antibody tests, while many have stuck to the contractual pricing that was established for those codes before the pandemic, which directly conflicts with the intent of the CARES Act.
As the demand for antibody testing grows and becomes an integral piece of return-to-work plans, XIFIN calls on payors to reduce the number of erroneous denials and adhere to Medicare’s guidance on appropriate reimbursement rates for the industry.
XIFIN's Self-Testing Leads the Way for Return-to-Work Protocols
As employers consider bringing more employees back to physical workplaces, XIFIN shared its COVID-19 and antibody testing protocol for employees who have been deemed essential personnel.
Partnering with a leading California laboratory and the company’s health insurer, XIFIN offered voluntary testing to its employees, by physician order. With plans in place to maintain a routine COVID-19 and antibody testing program for its employees, XIFIN’s framework can act as a model to enable the type of monitoring that will maintain employee and public confidence. Program highlights and findings included:
As businesses across the nation create their return-to-work protocols, dual testing frameworks will be critical in providing the scientific data needed for informed planning at the national, state, and local levels.