NEO: "What is the TC grandfather sunset?"
There was a billing clause that allowed genetics labs to independently bill medicare for the technical component of the testing and allow hospitals to bill for the professional services. NEO now has to bill the hospital for the technical component, which delays reimbursement. I believe that during the CC, mgmt provided details of the average days for accounts receivable, longer now in the past because of this change. There was no specific comment on any deals that NEO had to cut with the hospitals regarding changes in reimbursement, but I suspect that some discount was likely to keep these customers.
Peter's comment and link to the changes in CPT for genetics testing is clearly a concern, but I'm not certain to what degree this will impact reimbursement. The key issue appears to be "stacked" billing where the lab can charge for each individual procedure when multiple levels of genetics procedures are run on a single sample. Here is an excerpt from the article:
"For over a decade, the bane of coding for molecular tests has been the infamous issue of stacked codes. Unlike traditional assays, molecular tests do not have single, analyte-specific codes that labs can use to bill Medicare or private payers. Rather, a list of codes that signify each procedure involved in performing the assay are listed together. Each code describes a separate step or methodology performed to complete the test, such as gene amplification, nucleic acid extraction, or nucleic acid probes. For some tests, these codes must also be multiplied if the lab uses a step more than once to perform the test, especially in those tests that look at multiple markers.With payers closely watching what they pay for, providers and payers can now work together more closely to make sure patients receive appropriate care, Synovec emphasized. “Under the current system, when a set of stacked codes is submitted, the payer doesn’t know if it’s something medically appropriate or not, and some payers, out of frustration, globally don’t cover molecular stacking codes,” he said. “On the other side, patients are having experimental tests done that are not part of the patient’s insurance plan, but cannot be teased out of the current coding stack submitted for payment. The greater granularity will allow for a better understanding of the analytes being tested, test ordering patterns, and it will allow payers to determine how and which tests should be incorporated into the insurance plans for their beneficiaries.”"
