M Edye Conway 1 , Cassidi Dailey Kalejta 1 , Darci L Sternen 2 , Ila R Singh 3 Show Affiliations »
Abstract
OBJECTIVES: To demonstrate the impact of genetics specialists on identifying test order errors and improving reimbursement for genetic testing. METHODS: Forty-four cases in which whole exome sequencing (WES) was performed but not reimbursed were reviewed by a genetic counselor through simulated prospective and retrospective reviews. RESULTS: Fifty-two percent of WES requests were ordered by nongenetics providers. Retrospective review revealed that 50% of cases were denied because of contractual constraints on billing. If review by a genetic counselor had occurred in real time, modifications or cancellations would have been recommended in 82% of the cases. CONCLUSIONS: A laboratory stewardship program involving genetics experts identified test order errors and opportunities for improved reimbursement and cost savings. Significant variables affected reimbursement, including inpatient status, payer criteria, and ordering provider specialty. © American Society for Clinical Pathology, 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
OBJECTIVES: To demonstrate the impact of genetics specialists on identifying test order errors and improving reimbursement for genetic testing. METHODS: Forty-four cases in which whole exome sequencing (WES) was performed but not reimbursed were reviewed by a genetic counselor through simulated prospective and retrospective reviews. RESULTS: Fifty-two percent of WES requests were ordered by nongenetics providers. Retrospective review revealed that 50% of cases were denied because of contractual constraints on billing. If review by a genetic counselor had occurred in real time, modifications or cancellations would have been recommended in 82% of the cases. CONCLUSIONS: A laboratory stewardship program involving genetics experts identified test order errors and opportunities for improved reimbursement and cost savings. Significant variables affected reimbursement, including inpatient status, payer criteria, and ordering provider specialty. © American Society for Clinical Pathology, 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Keywords:
Laboratory stewardship; WES; eimbursement; enetic testing; enetics; hole exome sequencing; nsurance; reauthorization; rior authorization; tilization management
Year: 2020
PMID： 31802100 DOI： 10.1093/ajcp/aqz188
Source DB: PubMed Journal: Am J Clin Pathol ISSN： 0002-9173 Impact factor: 2.493