1. Molecular Pathology Economics 101: an Overview of Molecular Diagnostics Coding, Coverage and Reimbursement
- Author
-
Tara L. Burke, Sarah A. Thibault-Sennett, Anthony N. Sireci, Jay Patel, Loren Joseph, Oana Rosca, Dara L. Aisner, Matthew C. Hiemenz, and Samuel Caughron
- Subjects
0301 basic medicine ,MEDLINE ,Medicare ,Article ,Insurance Coverage ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Resource (project management) ,Multidisciplinary approach ,Stakeholder Participation ,Humans ,Reimbursement ,Government ,Molecular pathology ,Technological evolution ,Laboratories, Hospital ,United States ,030104 developmental biology ,Molecular Diagnostic Techniques ,030220 oncology & carcinogenesis ,Insurance, Health, Reimbursement ,Costs and Cost Analysis ,Government Regulation ,Molecular Medicine ,Engineering ethics ,Working group - Abstract
Widespread indications for use of molecular diagnostics in various aspects of clinical medicine have driven proliferation of testing. The rapid adoption and continuous technological evolution of molecular diagnostics have often strained the development and maintenance of a functional underlying framework of coding, coverage, and reimbursement policies, thereby presenting challenges to various stakeholders including molecular professionals, payers, and patients. A multidisciplinary working group convened by the Association for Molecular Pathology Economic Affairs Committee was tasked to describe the complex landscape of molecular pathology economics and highlight opportunities for member engagement. In this manuscript, on the basis of review and synthesis of government regulations and procedures, published payer policy documents, peer-reviewed literature, and expert consensus, the Working Group navigates the ecosystem of molecular pathology economics in terms of stakeholders, coding systems and processes, coverage policy determination, and pricing mechanisms. The composition and interrelatedness of various working groups and committees are emphasized in order to highlight the functional underpinnings of the system. Molecular professionals must be conversant in the language and complex inner workings of molecular pathology economics in order to lead successful, viable laboratories and advocate effectively for policy development on their behalf. This overview is provided to be a resource to molecular professionals as they navigate the reimbursement landscape.
- Published
- 2020