Over the past several years, Mercy Care has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards.
There are multiple Federal Agencies (e.g., Federal Drug Agency, U.S. Preventive Services Task Force) as well as numerous Professional Societies (e.g., American Society of Clinical Oncology, American College of Medical Genetics and Genomics, Clinical Pharmacogenetics Implementation Consortium) and Medical Literature that have concluded that many of the currently available genetic testing services are either experimental, investigational, or unproven (EIU). In addition, these same Agencies and Societies also consider some of these tests as non-covered when billed without an appropriate diagnosis.
Beginning with claims processed on April 1, 2022, Mercy Care will be instituting new payment policies for Genetic testing that will enforce the EIU criteria and/or the non-covered service criteria.
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