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Expansive Growth in Genetic Testing Demands Payment Integrity Solution

With nearly 160,000 genetic tests available in the US alone, and an anticipated global market expansion to 436,000 tests by 2026, the need for cost containment strategies has never been more urgent for health plans.

However, the complexity and unregulated nature of this space creates a breeding ground of egregious coding and billing practices. With only 400 CPT codes for 160,000 tests (and growing), labs resort to unbundling, code stacking, and miscoding, which not only inflate costs, but also disguise a test as medically necessary, when it is not.

While prior authorization (PA) programs aim to help, the volume of PAs for genetic testing alone is difficult to keep pace with, creating more administrative burdens and dangerous care delays for patients. Moreover, PA alone cannot address wide genetic test variability between labs and the numerous CPT and International Classification of Diseases, making accurate test identification nearly impossible.

A Holistic Approach to Payment Integrity for Health Plans

Download this white paper to explore the components of a successful Genetic Testing Payment Integrity program which includes:

  • Strategies to implement in a prepay environment that reduced genetic testing costs by $26.5M dollars for a single client.
  • Post-pay options to recoup on claims that should not have been paid in the first place, like one client who was able to identify $63M dollars in savings.
  • Ongoing quality control measures, monitoring and support from genomics experts that resulted in a 100% uphold rate for one client.
Get Your Copy Today

Implementing a payment integrity solution is a strategic move in an industry aspiring to make healthcare more affordable for everyone.

Download our white paper now to learn how Genetic Testing Payment Integrity can revolutionize your health plan’s approach to managing healthcare expenses.

Fill out the form below to download your FREE copy of our Case Study