Health Payer Specialist: Health Plans Must Change How They Manage Genetic Tests

Avalon Executive VP of Product Jason Bush, Ph.D., MBA, Lays Out Three Steps Needed to Improve Genetic Testing as Their Use Grows

Testing is already the highest-volume medical activity in this country, with more than 14 billion tests performed each year. Approximately 70% of clinical decisions are based on lab testing, but an estimated 30% of all tests are ordered in error, primarily due to overuse and unnecessary repeats.

Clinicians and health plans are struggling to determine which tests are the most valid, offer the greatest patient benefits, and should be covered. The challenge will become even more acute as states pass biomarker legislation requiring plans to include coverage for biomarker testing. As tests are being created faster than new CPT codes can be assigned to identify them, a proven solution requires precise codes, evidence-based policies designed by an independent review board, and an NCQA-accredited prior authorization process using precise coding to align payer reimbursement with authorization.

Read more at Health Payer Specialist.

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