Eliminating the Hidden Costs of Genetic Testing Claims
February 4, 2019
More than 75,000 genetic tests and testing products are on the market, with more than 10 new tests released each day. Many health plans are addressing rapid genetic testing growth with utilization management (UM) programs, such as prior authorization. These programs are effective in reducing inappropriate testing by helping ensure ordering providers make evidence-based testing decisions. But, only some tests are practical to manage this way. Additionally, even when preauthorization is obtained, the way the laboratory bills the test may still be out of policy. Thus, a key area of inappropriate genetic test cost is often overlooked: overbilling, and subsequent overpayment, for genetic tests.