XIFIN, the San Diego-based revenue cycle management company, has proposed new guidelines for the billing of molecular tests. In a recently released 28-page white paper, XIFIN noted that billing methodologies for molecular tests rarely take their ability to affect the long-term financial aspects of care under consideration (e.g., using a $3,000 test to determine whether $100,000 in treatment is required). Moreover, the tests are evolving so rapidly that they run the risk of becoming obsolete for medical purposes before commercial or government payers recognize their utility and assign a billing code. “Today’s antiquated regulatory and coverage protocols are inadequate for the rapid pace of molecular diagnostics advancements,” said Lâle White, XIFIN’s chief executive officer. “More importantly, the current regulatory system must recognize the economic value of these tests in order to support the rapid development and deployment of potentially life-saving diagnostics.” XIFIN proposed payments be developed along a sliding scale that shares risk between the developer of the test and the payer. Tests that have little impact on the course of treatment should be paid at a low rate. Tests that significantly alter the course of treatment should be paid at a higher rate. Tests that are more effective or […]
XIFIN, the San Diego-based revenue cycle management company, has proposed new guidelines for the billing of molecular tests.
In a recently released 28-page white paper, XIFIN noted that billing methodologies for molecular tests rarely take their ability to affect the long-term financial aspects of care under consideration (e.g., using a $3,000 test to determine whether $100,000 in treatment is required). Moreover, the tests are evolving so rapidly that they run the risk of becoming obsolete for medical purposes before commercial or government payers recognize their utility and assign a billing code.
“Today’s antiquated regulatory and coverage protocols are inadequate for the rapid pace of molecular diagnostics advancements,” said Lâle White, XIFIN’s chief executive officer. “More importantly, the current regulatory system must recognize the economic value of these tests in order to support the rapid development and deployment of potentially life-saving diagnostics.”
XIFIN proposed payments be developed along a sliding scale that shares risk between the developer of the test and the payer. Tests that have little impact on the course of treatment should be paid at a low rate. Tests that significantly alter the course of treatment should be paid at a higher rate. Tests that are more effective or more sensitive than the older assays they’re replacing should be reimbursed more than the older tests. If they have an additional medical benefit, such as allowing for an earlier diagnosis, they should command a higher reimbursement.
Company officials expect any adoption of this system to be incremental at best. Rina Wolf, XIFIN’s vice president of commercialization strategies, noted that these guidelines have been submitted as a trial balloon to both payers and Medicare administrative contractors.
“They’ve been positive as to the concept, but obviously it would be a total paradigm change, and it is not something we expect to happen overnight,” she said.
Takeaway: The current reimbursement system for molecular tests needs to be revamped in light of market considerations and impact on the patient’s care.
