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The process of DNA extraction to analyze gene mutation is about a decade old and relies heavily on manual data entry which is not only laborious, but also very difficult to manage with regard to applicable coding unique to the type of individual or payor. The outcome typically resulting in erroneous data, causing insurance denials, which in turn creates laboratory loss patterns to the tune of tens of millions of dollars annually.
Our proprietary software walks the patient or caregiver (depending on the application) through a series of questions to determine eligibility.
Often times doctors, lab agents, patients, and others are uneducated within the realm of molecular qualifications and what supporting letters of medical necessity are needed for insurance institutions to deem a “justifiable” candidate.
Tests, such as, CGx require a number of combined genetic cancers listed in a patient’s family aligned with certain ages of diagnosis to qualify. These cancers need to be in certain categories. Subsets include, BRCA, LYNCH, or others. This is tedious for physicians to stay up to date on. Our solution will connect all necessary dots needed through a fast and easy process which makes determining eligibility a breeze.
PGx also comes with challenges. Even if a person is regularly taking 10 or more medications it doesn’t mean they qualify to determine which medications they are able to metabolize. The medications they take must carry pharmacogenes and have corresponding levels of evidence. Our system will sort those Indicators for you based on listing the patient’s current pharmaceutical intake coupled with a list of questions needed for diagnosis probability.
Cardiovascular is another popular yet miss-dispensed test. In most cases the patient must have 3 or more qualifiers to generate ICD-10 codes for diagnosis’ such as Arrhythmia or others. Much like other molecular tests, the qualifying factors are complex and easy to misconstrue.
Our platform helps to determine who should be getting the test up front. If the software determines there is a near perfect score for eligibility it will generate the labs requisition forms, all applicable ICD-10 codes, CPT codes (for billing), and generate example medical necessity letters to serve as a guide to properly process the end user.
We make growing your lab business simple by removing the educational hurdles, erroneous data entry, and all headaches that come along with properly choosing candidates that will benefit from your labs extraordinary services.
We specialize in CGx, PGx, Cardiovascular, Alzheimer’s, Parkinson’s, Dementia, Carrier, Covid, Pathology, and many other molecular lab tests. Our goal is to continue to grow are data-driven algorithms and propel your lab towards perfection.