Jondavid Klipp of Laboratory Economics is sponsoring a teleconference on February 15 featuring speakers from XIFIN and CodeMap that will discuss reimbursement for molecular testing. It is of the utmost importance that laboratory medicine professionals understand the world in which we live with respect to reimbursement of molecular testing.
An increased recognition within the medical community and the lay public of the power of molecular testing, along with overutilization from self-referring clinicians utilizing client billing schemes, have led to a significant increase in the volume of molecular testing. As a result, some Medicare contractors are already taking steps to significantly decrease reimbursement for some molecular tests and outright decline reimbursement for others.
I have spoken with the medical director of one of these Medicare contractors who told me self-referring clinicians order, and expect payment for, all kinds of molecular tests that are not approved by the FDA or provide no proven patient care benefit. And not only that, a few of these shameless clinicians have the nerve to call the Medicare contractor and complain when the tests are not paid for, which of course prevents them from unethically profiting.
From Mr. Klipp:
Medicare carrier Palmetto GBA recently posted their reimbursement rates for 78 new molecular diagnostic test codes. Palmetto processes claims for several key states, including California. Based on a preliminary analysis by Laboratory Economics, the reimbursement for these 78 codes is down, on average, by more than 30% compared with the reimbursement labs had previously received under code-stack billing.
Laboratory Economics is sponsoring a special teleconference–Finding Success in the New Molecular Test Reimbursement Paradigm–on February 15. Featured speakers will be national experts Rina Wolf from XIFIN Inc. and Charles Root, PhD, from CodeMap LLC.
See www.laboratoryeconomics.com for more information.
Final national Medicare rates for molecular tests will be determined by CMS over the next six-to-nine months. This is a topic of critical concern to the future of laboratory medicine.