Summary: Concert has broadened its diagnostic benefit program to enhance payment and clinical policies and payment accuracy capabilities for lab testing, aiming to lower the overall costs for health plans and provide members with better access to essential clinical services.

Takeaways:

  1. Concert’s expanded Diagnostic Benefit Program provides transparent, evidence-based policies, a synchronized library of claim edits, and technical integration capabilities for customers.
  2. The program aims to facilitate clearer communication between providers, laboratories, and health plans, reducing confusion and errors related to coverage, coding, and reimbursement.
  3. Alongside the expansion of the Diagnostic Benefit Program, Concert announced the formation of a clinical advisory board.

Concert has expanded its Diagnostic Benefit Program to provide payment and clinical policies and payment accuracy capabilities across routine and advanced laboratory testing, enabling health plans to provide their members with access to these important clinical services at lower total costs, the company announced.

“Diagnostics are critical in the delivery of effective, personalized care. Unfortunately, ambiguity in coverage, coding, and reimbursement leads to waste and confusion as providers, laboratories, and health plans work together to serve patients,” says Rob Metcalf, CEO of Concert.

A Simplified Diagnostic Benefit Program

Laboratory testing has become complex and costly to manage, as new tests, evidence, clinical guidelines, and codes emerge rapidly. This quarter, almost 60 applications for Proprietary Laboratory Analyses (PLA) codes are under consideration.(1) Meanwhile, frequently ordered molecular oncology, pharmacogenetic. and infectious disease tests are commonly billed with more than 10 codes,(2) often obscuring the test that was performed. As a result of the rapid changes underway, many health plans’ policy and coding configurations lag behind the market, and payment errors are common.

The Diagnostic Benefit Program—formerly known as the Genetics Benefit Program—provides transparent, evidence-based policies, a synchronized library of claim edits, and technical integration capabilities that can deliver this content through the customer’s preferred clinical decision support and claims editing platforms. Together these enable plans to improve transparency, reduce administrative burden and achieve cost savings, all while keeping pace with the rapidly evolving market.

New Clinical Advisory Board

In a separate release, Concert announced the formation of a clinical advisory board, which will advise Concert on its expanding set of clinical policy content. Advisors include Drs Beth Harris, Thomas Holland, Girish Putcha, and Michele Schoonmaker.

“Expanding our clinical content, and the expertise that supports its development, means Concert can bring transparency, efficiency, and accurate reimbursement to more areas of care,” says Gillian Hooker, Concert’s chief scientific officer. “Our goal is to deliver clarity of coverage and costs all the way to the point of care, and today’s announcements represent important progress towards that goal.”

Along with today’s announcement, Concert Genetics says it will now operate by its abbreviated name, Concert, which many customers and partners have used for years to refer to the company.

References:

  1. For more information on CPT® PLA codes visit: https://www.ama-assn.org/practice-management/cpt/cpt-pla-codes. CPT® is a registered trademark of the American Medical Association.   
  2. Concert data