Payment Integrity Edits Identify $26.5M in Inappropriate Genetic Testing Payments
Driven by the rapid and ongoing increase in the number of genetic tests available on the market, genetic testing spending is projected to increase from $13B in 2020 to $29B by 2026. The growth and complexity of these tests create clinical and payment appropriateness challenges. And, overpayments still occur even if a plan has an effective utilization management program in place.
In this case study, we describe the payment integrity program that InformedDNA implemented with a large national health plan with more than nine million covered lives. By improving test identification, reviewing claims against medical policy, and identifying payment variations, the program enabled $26.5M in payment reductions on edited genetic testing claims a reduction equal to $0.25 PMPM.
With the nation’s largest employee staff of lab-independent genetics specialists, InformedDNA enables health plans to stay ahead of the curve by augmenting a plan’s in-house team with comprehensive clinical genetics expertise. We empower health plans to promote precision medicine, optimize spending, and avoid unnecessary and unpleasant experiences for members and providers.
Download your complimentary copy now.
[hubspot type=form portal=5192453 id=cafb94d5-04e0-4297-9b39-46d41837ef51]
