2015 Annual Training Conference & Anti-Fraud Expo

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Genetic and Biomarker Testing (Room Seaport C)

19 Nov 15

2:00 PM - 3:15 PM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Ksenia Coble, RN, CPC, Clinical Auditor, Humana; Kristine Bordenave, MD, FACP, Lead Medical Director, Special Investigations Unit & Provider Payment and Integrity, Humana

Expert faculty will explain the current genetic and biomarker testing environment and its current sales appeal in the US. The presenters will describe the methodologies used to perform the various tests and explain the associated coding. Through examples, faculty will demonstrate the identification of schemes used to obtain inappropriate maximum payment by payer systems and provide the existing and proposed criteria defining appropriate utilization and billing for this testing.

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