LanguageTerm (authority = ISO 639-3:2007); (type = text)
English
Abstract (type = abstract)
In 2007, the implementation of CPT code 96040 for “Medical Genetics and Genetic Counseling Services” allowed genetic counselors to bill directly for services and to regulate genetic counseling reimbursement. Lack of insurance coverage is a barrier of access to care for patients that needs to be addressed. This retrospective study examined reimbursement of reproductive genetic counseling encounters billed under 96040 at Rutgers Robert Wood Johnson Medical School, a regional perinatal center in New Jersey, a state requiring licensure. Descriptive statistics were tabulated to assess the difference between payer categories, (Medicare/Medicaid, Managed Care Medicaid, and commercial insurance), including how often encounters were reimbursed and if reimbursed, at what percentage of the amount billed. For commercial payers, a comparison of individual plan types (Health Maintenance Organization, Point of Service, and Preferred Provider Organization) was carried out. Trends in reimbursement were assessed over the eight-year period for payer types.
The study found that 61% of 60-minute encounters billed under 96040 were given any reimbursement. Of reimbursed encounters, the payer reimbursed only 36% of the amount billed. Medicare/Medicaid encounters were never reimbursed as the Centers for Medicare and Medicaid Services (CMS) do not recognize genetic counselors as credentialed providers nor recognize 96040. Commercial insurance reimbursed most often at 65% of encounters, but varied greatly between payer and individual plan type. There was an overall downward trend of the percentage of encounters reimbursed over the eight-year period.
In order to improve payer reimbursement, consistent infrastructure needs to be created for each payer type. While this has started with the introduction H.R 7083, “Access to Genetic Counselor Services Act of 2018” to recognize genetic counselors as CMS providers, the need is still present for other payers. If genetic counselors were deemed in-network providers for commercial payers, reimbursement could increase and be more consistent. For this to occur, advocacy on the local and national levels needs to focus on this effort to overcome this barrier of access to care.
Subject (authority = local)
Topic
Genetic counseling
Subject (authority = RUETD)
Topic
Microbiology and Molecular Genetics
Subject (authority = LCSH)
Topic
Health insurance
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
Identifier
ETD_9709
PhysicalDescription
Form (authority = gmd)
InternetMediaType
application/pdf
InternetMediaType
text/xml
Extent
1 online resource (iv, 27 pages) : illustrations
Note (type = degree)
M.S.
Note (type = bibliography)
Includes bibliographical references
RelatedItem (type = host)
TitleInfo
Title
School of Graduate Studies Electronic Theses and Dissertations
Identifier (type = local)
rucore10001600001
Location
PhysicalLocation (authority = marcorg); (displayLabel = Rutgers, The State University of New Jersey)
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.