Molecular (Genetic) Laboratory Billing
While genetic testing is a relatively new field of laboratory testing, it is growing at an exponential rate. Why? Because it provides patients with fact-based lab results which allow them to make informed decisions about medical care. Molecular testing also allows providers to suggest appropriate preventive care, monitoring protocol, and treatment options. By screening for key differences in chromosomes, genes, or proteins, medical providers can identify potential genetic disorders in both adults and children. There are thousands of tests currently in place with more being developed, and the three most common methods of genetic testing include molecular genetic tests, chromosomal genetic tests, and biochemical genetic tests. These tests can change the course of patients’ lives, but obstacles in billing make it difficult for laboratories to consistently provide this beneficial and much-needed service.
Challenges of Billing for Molecular Laboratory Testing
Laboratory Billing has always been challenging, but genetic testing has proven even more complex. Current Procedural Terminology (CPT) codes are the numbers assigned to every type of service that a medical practitioner can provide for their patient, including medical, diagnostic, and surgical services. There are specific codes for genetic testing; however, these codes are constantly changing. In 2018 alone there have been a total of fifty-seven new codes added to the CPT’s coding book, some even covering up to ten genes. For most labs—busy ones in particular—it becomes almost impossible to stay on top of regulatory changes, meaning denied claims and insufficient reimbursement. Another issue is with PAMA pricing, as they’ve proposed deep cuts to laboratory testing. This could be devastating to labs who provide these critical services, especially ones in rural areas and those with high Medicare volumes.
How a Medical Billing Service Company can Help
Although molecular/genetic testing is commonplace in the medical community, it can be a challenging task to get reimbursement from insurance companies. Many healthcare professionals have realized how beneficial testing can be for the patient’s overall health and plan of future care, but most insurance payers have been hesitant to get on board with it. Partnering with a medical billing service with certified medical billing specialists who specialize in molecular testing labs billing can change the way laboratories operate. Genetic billing specialists work closely with labs and medical providers, advocate on their behalf, and ensure labs receive maximum reimbursement for molecular testing.
Changing the Face of Healthcare
Rapidly advancing technology and testing have changed the face of healthcare. Because of it, we have a better understanding of genetic diseases and their impacts. It allows us to prevent and treat such conditions in ways that we’ve never been able to before, meaning that more lives are touched and saved. Molecular billing is difficult, but these challenges can be overcome with the help of a medical billing company that specializes in genetic testing. With the assistance and expertise of genetic laboratory billing specialists, labs and service provider can deliver hope and quality care to their patients without the financial risk.