Proven Payment Integrity Solution for Genetic Test Claims

  • May 06, 2020
  • 2:00 PM – 3:00 PM ET
  • online

In recent weeks, we’ve seen and felt how our clients and health plans as a whole are struggling to address COVID-19.  One study1 estimates between $3-$13 billion in unplanned new testing costs associated with the outbreak. In addition, fraudulent test billing2 is already increasing rapidly. InformedDNA has a solution that can help offset this increase by reducing inappropriate genetic test payments.

Inappropriate genetic test claims are often mistakenly paid because claims systems can’t identify the actual test(s) performed and apply correct policy. In fact, research shows that 30 percent of genetic testing claims are coded inaccurately. Other factors that contribute to higher-than-necessary costs for genetic testing include lack of medical necessity, volume billing, and widely variant allowed amounts for the same test.

Many health plans successfully manage appropriate genetic test selection by ordering providers through preauthorization processes. However, billing involves a different player: Labs. Our analyses and actual results are based on addressing lab billing practices that don’t sufficiently identify the test or panel being billed. This approach is wholly separate from managing the ordering provider decision pre-test. So, substantial savings opportunities exist even when a plan maintains an effective utilization management program for genetic tests.

Attendees will learn:

  • The impact of genetic testing cost trends on your plan’s genetic testing spend, at a time of drastically increased testing costs due to COVID-19
  • Practical strategies for reducing unnecessary genetic test claims payments, such as incorporating automated claims edits and payment rules into your pre-pay environment and post-pay recoupment strategies
  • How the results of genetic claims analysis can inform lab contract negotiations
  • How our approach saved $0.25 PMPM in its first year

Click here to learn more about InformedDNA’s Payment Integrity Solution for genetic test claims.”


Kelle Steenblock
Vice President, Payment Integrity
Informed DNA

Kelle leads InformedDNA’s payment integrity business. As a board-certified genetic counselor since 2002, she has experience in the areas of cancer, neurogenetics, reproductive genetics, and worked for several years as an embryologist. Prior to joining InformedDNA more than 12 years ago, Kelle worked as a genetic counselor at Hennepin County Medical Center and at the Mayo Clinic Molecular Genetics Lab where she was involved in clinical process development, colon cancer research, appropriateness of testing, and development of the preimplantation genetic diagnosis (PGD) program. She holds a B.A. in Biology from Gustavus Adolphus College and an M.S. in Genetic Counseling from Northwestern University.

John Gaines
Vice President, Client Development

John has more than 30 years of diverse experience across health plans, health systems, physician organizations and healthcare IT vendors. He leads a number of growth initiatives for InformedDNA, including management of key relationships. Previously, John was at McKesson Corporation, where he helped lead the growth of the company’s genetic test-related products. He has also held leadership positions with PricewaterhouseCoopers, Montefiore Medical Center and Siebel Systems. John holds a B.A. in Economics from Cornell University.

1: Covered California. (3/24/2020). “Covered California Releases the First National Projection of the Coronavirus (COVID-19) Pandemic’s Cost to Millions of Americans With Employer or Individual Insurance Coverage.” Press release.

2: Brodwin, Erin. (3/21/2020). “As public hungers for coronavirus tests, FDA warns new at-home kits are ‘unauthorized’.” STAT.

" "