The Evolution of Whole Exome Medical Policy: Payer Coverage and What Clinicians Need to Know with Stephanie Gandomi, MS, MBA, CGC, CPC

• From a healthcare perspective, Whole Exome Sequencing (WES) is still considered a new diagnostic resource for patients looking to obtain an answer for their underlying genetic condition. As a result of its novelty in medicine, private and government payer policies outlining whole exome sequencing coverage have slowly evolved over the last decade. Although, this evolution has led to improved access to care and increased diagnostic yield, challenges still impact clinical practice for clinicians and patients alike. In this webinar, we will examine the evolution of payer policies regarding coverage for WES, compare the different payer policies as they currently exist, and define critical components of the prior authorization, claims submission, and appeals processes that can impact coverage opportunities for patient accessibility to care.

  Level of Instruction: Intermediate

  

  Only the live session qualifies for CEUs but when possible, we host the recordings on our website and NSGC recommends participants to use their personal email instead of work email addresses to ensure they receive their CEU certificates.

  

  Ambry Genetics is approved as a provider for continuing education program by NSGC and ASCLS P.A.C.E ® Program.

Stephanie Gandomi, MS, MBA, CGC, CPC, CPCO | Presenter

Health Plans Director - Policy Specialist, Ambry Genetics

Stephanie Gandomi earned her Master of Science in genetic counseling at Brandeis University in 2006 and her MBA from Boise State University in 2019. She is currently the Health Plans Director-Policy Specialist at Ambry Genetics and is also an AAPC Certified Professional CPT Coder. Early in her career, Stephanie co-founded the Lucile Packard Children’s Hospital at Stanford Perinatal Diagnostic Center in Salinas and served as a Community Health Supervisor for the State of California Genetic Disease Branch, Prenatal Screening program at UC Davis. In 2013, Stephanie moved into molecular diagnostics at Ambry Genetics as Product Manager for Clinical Genomics and then subsequently at Invitae in Medical Affairs for neurology and rare diseases. In 2016, Stephanie became the first genetic counselor in “the Blues system” of payers as the Principal Program Manager for Precision Medicine at Blue Shield of California. She most recently held the Director of Genetics position at UnitedHealthcare until 2020, when she returned to Ambry. Stephanie is an active member in the National Society of Genetic Counselors. She has authored numerous peer-reviewed journal articles related to undiagnosed disorders, pediatric syndromes, next-generation sequencing, and has given numerous payer-related presentations on medical policy, utilization management, coding trends, and professional development in genetics. Stephanie is also actively involved with her family and three children, her local church ministry, and volunteers as a business advisor for a non-profit Polynesian Cultural Center in Kamuela, Hawaii.

Catherine Schultz, MS, CGC | Moderator

Senior Genomic Science Liaison, Ambry Genetics

Catherine Schultz is a certified genetic counselor and Senior Genomic Science Liaison at Ambry Genetics. She completed her BS in Biology at the College of Charleston and received her MS in Genetic Counseling from the University of Alabama at Birmingham. After graduate school, Catherine worked for several years as a multidisciplinary genetic counselor at University of Alabama at Birmingham in Birmingham, AL. In 2016 she moved to Oklahoma City and transitioned to her current role at Ambry Genetics. As a Genomic Science Liaison for the Southcentral United States, she serves as a clinical liaison for the field team to educate health care providers and other key opinion leaders on genetic testing and genomic medicine.