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Journal of Genetic Counseling

, Volume 26, Issue 4, pp 657–668 | Cite as

Development of a Streamlined Work Flow for Handling Patients’ Genetic Testing Insurance Authorizations

  • Wendy R. UhlmannEmail author
  • Katie Schwalm
  • Victoria M. Raymond
Professional Issue

Abstract

Obtaining genetic testing insurance authorizations for patients is a complex, time-involved process often requiring genetic counselor (GC) and physician involvement. In an effort to mitigate this complexity and meet the increasing number of genetic testing insurance authorization requests, GCs formed a novel partnership with an industrial engineer (IE) and a patient services associate (PSA) to develop a streamlined work flow. Eight genetics clinics and five specialty clinics at the University of Michigan were surveyed to obtain benchmarking data. Tasks needed for genetic testing insurance authorization were outlined and time-saving work flow changes were introduced including 1) creation of an Excel password-protected shared database between GCs and PSAs, used for initiating insurance authorization requests, tracking and follow-up 2) instituting the PSAs sending GCs a pre-clinic email noting each patients’ genetic testing insurance coverage 3) inclusion of test medical necessity documentation in the clinic visit summary note instead of writing a separate insurance letter and 4) PSAs development of a manual with insurance providers and genetic testing laboratories information. These work flow changes made it more efficient to request and track genetic testing insurance authorizations for patients, enhanced GCs and PSAs communication, and reduced tasks done by clinicians.

Keywords

Genetic testing Genetic counselors Insurance authorization Insurance issues Lean evaluation Patient services associates Industrial engineer 

Notes

Acknowledgements

We would like to thank the clinics that completed the surveys and follow-up interviews. In addition, we would like to thank Tammy Ellies, MBA (Senior Industrial Engineer and Lean Coach), Debra Grzeskowiak (Patient Services Associate), Demetria Bronaugh (Patient Services Associate) for their work in our lean evaluation, Beth Lawless for identifying clinics that order high volumes of genetic tests, Lauren Hipp, MS, CGC for contributing improvements to the shared database and our genetic counselor colleagues in the Division of Molecular Medicine and Genetics for providing input as the work flows were instituted. We especially would like to acknowledge the leadership of the Department of Internal Medicine for initiating and funding our work with the Performance Improvement Team.

Compliance with Ethical Standards

Conflict of Interest

Wendy R. Uhlmann, Katie Schwalm and Victoria M. Raymond declare that they have no conflicts of interest.

Ethical Treatment of Subjects

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all participants for being included in the study. No animal studies were carried out by the authors for this article.

References

  1. American College of Medical Genetics and Genomics Board of Directors. (2015). Clinical utility of genetic and genomic services: A position statement of the American College of Medical Genetics and Genomics. Genetics in Medicine, 17, 68–69.CrossRefGoogle Scholar
  2. Brown, S., Puumala, S., Leonhard, J., Bell, M., Dean, L.W., Flanagan, J., & Stein, Q. (2016a). Genesurance: Genetic counselors roles and responsibilities in regards to genetic insurance and financial topics. American College of Medical Genetics and Genomics 2016 Annual Clinical Genetics Meeting. https://acmg.expoplanner.com/index.cfm?do=expomap.sess&event_id=7&session_id=1272. Accessed 12 March 2017.
  3. Brown, S., Puumala, S., Leonhard, J., Bell, M., Dean, L.W., Flanagan, J., Stein, Q. (2016b). Genesurance: The mysterious element of genetic counseling. Presented abstracts from the 35th Annual Education Conference of the National Society of genetic counselors (Seattle, WA, September 2016). Journal of Genetic Counseling 25: 1359. Epublished 2016 Oct 12 [Accessed 2017 March 12].Google Scholar
  4. Burke, W. (2014). Genetic tests: Clinical validity and clinical utility. Current Protocols in Human Genetics, 81, 9.15.1-8. doi: 10.1002/0471142905.hg0915s81
  5. Capasso, J. E. (2014). The cost of genetic testing for ocular disease: Who pays? Current Opinion in Ophthalmology, 25, 394–399.CrossRefPubMedGoogle Scholar
  6. GeneTests (2017) http://www.genetests.org. Accessed 12 March 2017.
  7. Genetic Testing Registry (2017) http://www.ncbi.nlm.nih.gov/gtr/. Accessed 12 March 2017.
  8. Latchaw, M., Ormond, K., Smith, M., Richardson, J., & Wicklund, C. (2010). Health insurance coverage of genetic services in Illinois. Genetics in Medicine, 12, 525–531.CrossRefPubMedGoogle Scholar
  9. National Society of Genetic Counselors (2016). National society of genetic counselors strategic plan 2016–2018, Chicago. file:///C:/Users/wuhlmann/Downloads/NSGC%20Strategic%20Plan%202016%20-%202018%20Approved%203-24-16.pdf. Accessed 12 March 2017.Google Scholar
  10. Prince, A. E. R. (2015). Prevention for those who can pay: Insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease. Journal of Law and the Biosciences, 2, 365–395.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Secretary’s Advisory Committee on Genetics, Health and Society (2006). Coverage and Reimbursement of Genetic Tests and Services. http://osp.od.nih.gov/sites/default/files/CR_report.pdf. Accessed 12 March 2017.
  12. Spoonamore, K. G., & Johnson, N. M. (2016). Who pays? Coverage challenges for cardiovascular genetic testing in U.S. patients. Frontiers in Cardiovascular Medicine, 3, 1–6.CrossRefGoogle Scholar
  13. Uhlmann, W. R. (2009). Thinking it all through: Case preparation and management. In W. R. Uhlmann, J. L. Schuette, & B. M. Yashar (Eds.), A guide to genetic counseling (2nd ed., pp. 93–130). Wiley-Blackwell, John Wiley & Sons Inc: Hoboken.Google Scholar
  14. Uhlmann, W. R., & Sharp, R. R. (2012). Genetic testing integration panels (GTIPS): A novel approach for considering integration of direct-to-consumer and other new genetic tests into patient care. Journal of Genetic Counseling, 21, 374–381.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Wang, G., Beattie, M. S., Ponce, N. A., & Phillips, K. A. (2011). Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling. Genetics in Medicine, 13, 1045–1050.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Williams, C., Fan, J., Figueroa, S., Howell, J., Gotway, G., Park, J. (2016). Custom EPIC work queue to improve insurance coverage of genetic testing. Presented abstracts from the 35th Annual Education Conference of the National Society of Genetic Counselors (Seattle, WA, September 2016). Journal of Genetic Counseling 25: 1349. Epublished 2016 Oct 12. [Accessed 2017 March 12].Google Scholar

Copyright information

© National Society of Genetic Counselors, Inc. 2017

Authors and Affiliations

  • Wendy R. Uhlmann
    • 1
    • 2
    • 3
    Email author
  • Katie Schwalm
    • 4
  • Victoria M. Raymond
    • 1
    • 5
  1. 1.Division of Molecular Medicine and Genetics, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Department of Human GeneticsUniversity of MichiganAnn ArborUSA
  3. 3.Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborUSA
  4. 4.Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  5. 5.Trovagene Inc.San DiegoUSA

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