More than 70,000 genetic tests are on the market, with more than 10 new tests released each day. As health plans struggle to manage genetic tests appropriately, one area of hidden costs often is overlooked: overbilling for genetic tests.
Research shows 30 percent of genetic testing claims are coded inaccurately—and this has a significant impact on the expense payers incur for genetic tests. Other factors that contribute to higher-than-necessary costs for genetic testing include lack of medical necessity, volume billing (such as unnecessary multiple unit billing), and widely variant allowed amounts for the same test. Substantial savings opportunities exist even when the plan maintains an effective utilization management program for genetic tests.
This webinar will explore four practical strategies for reducing unnecessary genetic claims payments, which typically occur when:
- Payers’ claims systems can’t identify the actual test performed;
- Codes, or unit counts of codes, are inappropriate to bill for the specific test;
- Non-covered tests are billed and paid;
- Allowed amounts vary 10-20X for the same test.
This webinar took place with AHIP on January 22, 2019.