In the world of molecular genetic testing, one test can run upwards of $10,000. Insurance companies, nervous about these rising costs and the lack of research surrounding the effectiveness of the tests, are pumping the breaks on reimbursements for molecular genetics tests.
According to an article posted on Dark Daily, labs that are running these diagnostic genetic tests are stuck hoping that the insurance companies will cover it. As the demand for tests go up – by projected $15 billion by 2021 – the reimbursements are declining by almost 10%.
Instead of futile attempts to appeal reimbursement decisions, labs can start with a holistic, 360-degree view of a payer profile with hc1.com's Revenue Insight dashboards. These intuitive dashboards allow users to compare clients or prospects by insurance provider, test mix, and case mix, allowing for more a more strategic approach to upselling or finding new accounts. When labs have a transparent view of payer profiles, they can determine which clients are likely to pay in full for which tests, or which insurance providers reimburse at a higher rate.
In the molecular genetic testing space, it is easy to get caught up in the excitement of the cutting-edge science and lose track of the business side of running a molecular laboratory. One of hc1.com's clients, PGXL Laboratories, was so busy promoting their new molecular genetics test that they didn't realize they were not actually being paid for the tests until months later.
Having access to payer profiles and reimbursement trends allows labs to focus on critical issues – such as proving the effectiveness of molecular genetics tests to payers in order to increase reimbursement rates.
To learn how hc1.com can help your lab identify the most profitable clients, contact us today!