Skip to main content
Erschienen in: Journal of Genetic Counseling 4/2017

24.04.2017 | Professional Issue

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

verfasst von: Wendy R. Uhlmann, Katie Schwalm, Victoria M. Raymond

Erschienen in: Journal of Genetic Counseling | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

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.
Literatur
Zurück zum Zitat 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.CrossRef 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.CrossRef
Zurück zum Zitat 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]. 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].
Zurück zum Zitat Capasso, J. E. (2014). The cost of genetic testing for ocular disease: Who pays? Current Opinion in Ophthalmology, 25, 394–399.CrossRefPubMed Capasso, J. E. (2014). The cost of genetic testing for ocular disease: Who pays? Current Opinion in Ophthalmology, 25, 394–399.CrossRefPubMed
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
Zurück zum Zitat 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.CrossRef 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.CrossRef
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
Zurück zum Zitat 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]. 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].
Metadaten
Titel
Development of a Streamlined Work Flow for Handling Patients’ Genetic Testing Insurance Authorizations
verfasst von
Wendy R. Uhlmann
Katie Schwalm
Victoria M. Raymond
Publikationsdatum
24.04.2017
Verlag
Springer US
Erschienen in
Journal of Genetic Counseling / Ausgabe 4/2017
Print ISSN: 1059-7700
Elektronische ISSN: 1573-3599
DOI
https://doi.org/10.1007/s10897-017-0098-3

Weitere Artikel der Ausgabe 4/2017

Journal of Genetic Counseling 4/2017 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.