{"id":759,"date":"2021-08-26T14:45:32","date_gmt":"2021-08-26T14:45:32","guid":{"rendered":"https:\/\/www.concert.co\/concert-genetics-launches-genetic-test-payment-accuracy-solution-for-medicare-and-medicare-advantage\/"},"modified":"2024-04-18T21:03:00","modified_gmt":"2024-04-18T21:03:00","slug":"concert-genetics-launches-genetic-test-payment-accuracy-solution-for-medicare-and-medicare-advantage","status":"publish","type":"post","link":"https:\/\/www.concert.co\/blog\/concert-genetics-launches-genetic-test-payment-accuracy-solution-for-medicare-and-medicare-advantage\/","title":{"rendered":"Concert Genetics Launches Genetic Test Payment Accuracy Solution for Medicare and Medicare Advantage"},"content":{"rendered":"
Solution delivers payment accuracy and billing compliance in one of Medicare\u2019s highest growth segments<\/div>\n

NASHVILLE, Tenn. (Aug 26, 2021) \u2013<\/strong> Concert Genetics has launched a genetic testing payment accuracy and compliance solution for Medicare and Medicare Advantage plans. The offering extends Concert\u2019s innovative solution for commercial plans, providing unparalleled test identification, coding consistency, and automated determination of coverage to address both compliance and cost of care needs.<\/p>\n

Payment accuracy in genetic testing is an urgent issue. In Medicare Fee For Service (FFS), which represents nearly 60% of the total Medicare beneficiary population, spending on genetic tests grew 47% annually<\/a> from $289 million in 2015 to $1.36 billion in 2019, offsetting any reduction in laboratory spending expected to result from the Protecting Access to Medicare Act (PAMA), according to the U.S. Department of Health and Human Services Office of Inspector General. Meanwhile, the U.S. Department of Justice revealed more than $2.1 billion in losses<\/a> due to fraudulent genetic testing billing, which it called \u201cone of the largest health care fraud schemes ever charged.\u201d<\/p>\n

In addition to the cost of payment errors, complexity in genetic testing increases administrative expense and raises compliance risks. Research from Concert Genetics has shown multi-gene tests are often billed using 10 or more codes<\/a> in thousands of combinations. With hundreds of genetics laboratories distributed across the country, Medicare Advantage plans must also contend with different coverage, coding, and billing guidance based on the Medicare Administrative Contractor (MAC) jurisdiction of the rendering laboratory.<\/p>\n

\u201cGenetic testing management is costly and administratively burdensome for Medicare plan administrators, and the cost is ultimately borne by the taxpayers they represent,\u201d said Rob Metcalf, CEO of Concert Genetics. \u201cBy identifying specific tests, applying coding standards, and enforcing jurisdiction-specific coverage criteria, all in real time, Concert can deliver significant value to health plans and to the healthcare ecosystem.\u201d<\/p>\n

Concert\u2019s Medicare solution leverages a unique combination of assets and capabilities that include:<\/p>\n