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The proliferation of molecular diagnostics is bringing a tidal wave of complexity, cost and quality issues for payers, clinicians and laboratories. Although clinical laboratory testing costs represent only 3 percent of total health care costs, diagnostic testing influences 70 percent of all health care decisions. Therefore, payers are accelerating efforts to appropriately manage the utilization and reimbursement of molecular diagnostics and genetic tests. Payer initiatives include developing utilization management programs, such as pre-authorizations r notifications, to identify genetic and molecular tests using stacked codes, ensure medical appropriateness, and encourage increased use of in-network laboratories.
Payers will likely require pre-authorization/ notification for clinical laboratories and pathology groups, just as they have done for radiology. To stay ahead of evolving requirements, successful laboratories are deploying technology to collaborate real-time with clinicians, payers and other laboratories. In addition to making payer rules, benefits and coverage policies transparent to ordering clinicians, patients and laboratories at the point of care (or within the context of an order, successful technology deployments enable early adopters to further penetrate their market, increase clinician loyalty and better manage their utilization and relationships with payers.
The Dark Report is happy to offer our readers a chance to download our recently published FREE White Paper “Getting Paid for Molecular Tests: How Clinical Laboratories and Pathology Groups Should Respond to Pre-Authorization Requirements by Payers” at absolutely no charge. This free download will provide readers with a detailed overview of current legal challenges that your lab may encounter in the near future.
Here is just some of what you will take away…
- Why Payer Pre-Authorization and/or Notification for Genetic Molecular Tests Will Become Widespread
- The Advantages of Automated Payer Communication
- A Systematic Approach to Evaluating Genetic and Molecular Test Claims
- For more about How Clinical Laboratories and Pathology Groups Should Respond to Pre-Authorization Requirements, please CLICK HERE
Table of Contents
Chapter 1. Current Status of Managed Care Requirements for Coding, Claim Submission and Reimbursement of Molecular Tests
Chapter 2. Why Payer Pre-Authorization and/or Notification for Genetic Molecular Tests Will Become Widespread
Chapter 3. Existing Differences Among Payers in Pre-Authorization of Genetic and Molecular Tests
Chapter 4. Advantages of Automated Payer Communication
Chapter 5. A Systematic Approach to Evaluating Genetic and Molecular Test Claims
Chapter 6. Case Study: Improving Clinical, Operational and Financial Performance in the Laboratory
Chapter 7. Conclusion
A-1 About Matthew Zubiller
A-2 About McKesson
A-3 About DARK DAILY
A-4 About The Dark Intelligence Group, Inc., and The Dark Report
A-5 About Executive War College on Laboratory and Pathology Management
A-6 About Karen Appold