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

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 forme...

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Bibliographic Details
Published in:Journal of genetic counseling 2017-08, Vol.26 (4), p.657-668
Main Authors: Uhlmann, Wendy R., Schwalm, Katie, Raymond, Victoria M.
Format: Article
Language:English
Subjects:
Ambulatory Care Facilities - organization & administration
Authorization
Authorizations
Benchmarking - organization & administration
Biomedical and Life Sciences
Biomedicine
Clinical Psychology
Clinics
Email
Ethics
Genetic counseling
Genetic counselors
Genetic screening
Genetic Testing
Gynecology
Human Genetics
Humans
Industrial engineer
Insurance authorization
Insurance coverage
Insurance issues
Insurance, Health - organization & administration
Lean evaluation
Patient services associates
Professional Issue
Public Health
Testing laboratories
Tracking
Workflow
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Summary: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.
ISSN:1059-7700
1573-3599
DOI:10.1007/s10897-017-0098-3