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

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.

Impacts of genesurance considerations on genetic counselors' practice and attitudes

“…answering patient questions daily and never giving exact out-ofpocket costs. The timing of tasks was less variable among respondents, but as previous studies have shown, these data indicated that many tasks are completed outside of direct patient counseling (Attard, Carmany, & Trepanier, 2018;Uhlmann et al, 2017).…”

Head and neck paragangliomas: A two‐decade institutional experience and algorithm for management

“…36 However, although some genotypephenotype correlations in specific SDHx-related HNPGL are evident, 37 there is a significant clinical overlap of syndromes caused by different SDHx mutations. For this reason, and as genetic testing becomes more accessible and affordable, 38 initial screening for known pathogenic mutations in all 12 of the known hereditary susceptibility genes likely improves sensitivity and patient care in this population.…”

Optimizing efficiency and skill utilization: Analysis of genetic counselors' attitudes regarding delegation in a clinical setting

“…Delegation to numerous staff positions including personnel to manage insurance authorization (Uhlmann, Schwalm, & Raymond, ), genetic counseling assistants (Pirzadeh‐Miller et al, ), and additional clinical personnel (i.e. non‐genetics professionals) can directly aid in the genetic counseling process (Cohen et al, ; Cohen & McIlvried, ; O'Shea et al, ).…”