Abstract
Chris Anderson, Editor in Chief
It's easy to see that the job of genetic counselors has changed significantly in the past 10 years. Key drivers of this change have been the advent of next-generation sequencing, which has allowed for the development of a broad array of clinical genomic tests, and the continued maturation of consumer-focused genetic testing services like 23andMe and Ancestry, among others.
Gone are the days when most genetic counseling was provided through large health systems and academic medical centers. Today, people in need of genetic counseling services are just as likely to get them via a phone call or video chat as they are to receive them in person (see Genetic Counseling 2.0, page 20).
But as the profession has broadened and modernized to nimbly accommodate the changes in the genetics landscape, the Centers for Medicare & Medicaid Services (CMS) still does not recognize genetic counselors as health-care providers. In other words, a certified genetic counselor who provides services to a Medicare beneficiary can not bill Medicare for their services, even though doctors and other recognized providers who may not have any experience in genetic counseling can.
In an attempt to correct this oversight, industry groups including the National Association of Genetic Counselors (NSGC) have worked to introduce H.R. 3235, a bill which would allow genetic counselors to be recognized as providers and to bill their services at 85% of the rate Medicare pays to recognized providers.
As the NSGC sees it, getting 3235 enacted into law would recognize an increasingly valuable service provided by trained counselors, while also potentially providing long-term cost savings.
Erica Ramos, director of clinical product development for Geisinger National Precision Health, noted that these current CMS billing regulations leave out a large portion of the U.S. population that, as a result, is likely underserved. And there would potentially be follow-on effects from that passage of 3235 as well.
“Third party payers often follow Medicare and Medicaid in terms of how much they reimburse and what types of codes they reimburse for,” Ramos added. “There are big gaps now in how independently we can practice and how we can ensure that genetic counselors can bill for the services they provide.”
NSGC president Amy Sturm agreed that creating a path for genetic counselors to bill Medicare should bring around those private payers who currently don't reimburse for these services, but also noted it would help Medicare catch up with some private payers that have reimbursed for genetic counseling for some time.
“This is Medicare modernization,” Sturm said. “Because even though genetic counseling has been around since the 60s, Medicare is slow-acting and it takes them some time to catch up. This is to get them up to speed to recognize genetic counselors as providers under Medicare so that we can be billing for genetic counseling because other providers can, even though they might not have the expertise that a genetic counselor has.”