ABGC Domain 5 Mastery: Healthcare Systems &
Professional Practice Test Bank (2025 Guidelines-Aligned)
Domain 5: Healthcare Systems and Professional Practice
Subdomain 5a: Financial/Reimbursement Issues
Question 1
A genetic counselor is seeking prior authorization for exome
sequencing for a pediatric patient with intellectual disability. Which
resource is MOST critical to guide this process?
A) ACMG’s Incidental Findings Disclosure Checklist
B) NSGC’s Code of Ethics
C) ACMG’s Insurance Coverage Advocacy Toolkit
D) FDA’s LDT Regulation Guidelines
Answer: C) ACMG’s Insurance Coverage Advocacy Toolkit
Rationale:
The ACMG toolkit provides step-by-step guidance on navigating
payer requirements, including drafting medical necessity letters
and addressing prior authorization challenges.
Incidental Findings Checklist (A) relates to consent, not
reimbursement. FDA’s LDT guidelines (D) focus on laboratory
testing regulations.
Source: ACMG’s Insurance Coverage Advocacy Toolkit (2025).
Question 2
Medicare denies coverage for exome sequencing, citing lack of
"Coverage with Evidence Development" (CED) criteria. What is the
,counselor’s NEXT step?
A) Appeal with peer-reviewed literature on diagnostic yield.
B) Submit a revised medical necessity letter aligning with CED
requirements.
C) Recommend self-pay options to the patient.
D) Escalate to the NSGC Ethics Board.
Answer: B) Submit a revised medical necessity letter aligning with
CED requirements.
Rationale:
Medicare’s CED requires evidence that testing contributes to
clinical research. Revising the letter to address this framework is
critical for approval.
Peer-reviewed literature (A) may not address payer-specific
criteria. Source: Medicare’s 2024 CED Policy Update.
Subdomain 5b: Legal/Ethical Requirements
Question 1
A telehealth counselor accidentally shares a patient’s genetic report
via unencrypted email. Which regulation does this violate?
A) Genetic Information Privacy Act (2024)
B) FDA’s LDT Regulations
C) ACGC’s Scope of Practice Amendments
D) NSGC’s JEDI Competencies
Answer: A) Genetic Information Privacy Act (2024)
Rationale:
, The 2024 Genetic Information Privacy Act mandates encrypted
transmission of genetic data. Unsecured email breaches this
requirement.
FDA’s LDT Regulations (B) govern laboratory testing, not data
sharing. Source: Genetic Information Privacy Act, Section 3.1
(2024).
Question 2
A patient refuses to share a BRCA1 result with siblings. Using
NSGC’s Decision-Making Model for Conflict Resolution, what
should the counselor prioritize FIRST?
A) Disclose the result to protect the siblings’ health.
B) Explore the patient’s reasons for refusal.
C) Consult the institution’s legal team.
D) Document the refusal in the medical record.
Answer: B) Explore the patient’s reasons for refusal.
Rationale:
NSGC’s model emphasizes understanding patient perspectives
before balancing ethical/legal obligations.
Immediate disclosure (A) violates autonomy without due
process. Source: NSGC’s Decision-Making Model for Conflict
Resolution (2025).
Subdomain 5c: Professional Frameworks
Question 1
, A genetic counselor plans a quality improvement (QI) project to
reduce wait times for cancer risk assessments. Which resource
provides standardized metrics?
A) ACMG’s QI Metrics for Genetic Services
B) NSGC’s JEDI Competencies
C) Medicare’s CED Framework
D) FDA’s LDT Compliance Checklist
Answer: A) ACMG’s QI Metrics for Genetic Services
Rationale:
ACMG’s QI Metrics offer benchmarks for service efficiency and
patient outcomes, critical for QI projects.
JEDI Competencies (B) address equity, not operational
metrics. Source: ACMG QI Metrics for Genetic Services (2025).
Question 2
Under ACGC’s 2025 Scope of Practice Amendments, which activity
is NOW within a genetic counselor’s scope?
A) Prescribing pharmacogenomic-guided antidepressants.
B) Ordering diagnostic exome sequencing independently.
C) Performing venipuncture for genetic testing.
D) Supervising clinical trials for gene therapies.
Answer: B) Ordering diagnostic exome sequencing independently.
Rationale:
The 2025 amendments expand roles to include independent test
ordering in some states, though prescribing (A) remains outside
scope.
Source: ACGC’s 2025 Scope of Practice Amendments, Section
2.3.
Professional Practice Test Bank (2025 Guidelines-Aligned)
Domain 5: Healthcare Systems and Professional Practice
Subdomain 5a: Financial/Reimbursement Issues
Question 1
A genetic counselor is seeking prior authorization for exome
sequencing for a pediatric patient with intellectual disability. Which
resource is MOST critical to guide this process?
A) ACMG’s Incidental Findings Disclosure Checklist
B) NSGC’s Code of Ethics
C) ACMG’s Insurance Coverage Advocacy Toolkit
D) FDA’s LDT Regulation Guidelines
Answer: C) ACMG’s Insurance Coverage Advocacy Toolkit
Rationale:
The ACMG toolkit provides step-by-step guidance on navigating
payer requirements, including drafting medical necessity letters
and addressing prior authorization challenges.
Incidental Findings Checklist (A) relates to consent, not
reimbursement. FDA’s LDT guidelines (D) focus on laboratory
testing regulations.
Source: ACMG’s Insurance Coverage Advocacy Toolkit (2025).
Question 2
Medicare denies coverage for exome sequencing, citing lack of
"Coverage with Evidence Development" (CED) criteria. What is the
,counselor’s NEXT step?
A) Appeal with peer-reviewed literature on diagnostic yield.
B) Submit a revised medical necessity letter aligning with CED
requirements.
C) Recommend self-pay options to the patient.
D) Escalate to the NSGC Ethics Board.
Answer: B) Submit a revised medical necessity letter aligning with
CED requirements.
Rationale:
Medicare’s CED requires evidence that testing contributes to
clinical research. Revising the letter to address this framework is
critical for approval.
Peer-reviewed literature (A) may not address payer-specific
criteria. Source: Medicare’s 2024 CED Policy Update.
Subdomain 5b: Legal/Ethical Requirements
Question 1
A telehealth counselor accidentally shares a patient’s genetic report
via unencrypted email. Which regulation does this violate?
A) Genetic Information Privacy Act (2024)
B) FDA’s LDT Regulations
C) ACGC’s Scope of Practice Amendments
D) NSGC’s JEDI Competencies
Answer: A) Genetic Information Privacy Act (2024)
Rationale:
, The 2024 Genetic Information Privacy Act mandates encrypted
transmission of genetic data. Unsecured email breaches this
requirement.
FDA’s LDT Regulations (B) govern laboratory testing, not data
sharing. Source: Genetic Information Privacy Act, Section 3.1
(2024).
Question 2
A patient refuses to share a BRCA1 result with siblings. Using
NSGC’s Decision-Making Model for Conflict Resolution, what
should the counselor prioritize FIRST?
A) Disclose the result to protect the siblings’ health.
B) Explore the patient’s reasons for refusal.
C) Consult the institution’s legal team.
D) Document the refusal in the medical record.
Answer: B) Explore the patient’s reasons for refusal.
Rationale:
NSGC’s model emphasizes understanding patient perspectives
before balancing ethical/legal obligations.
Immediate disclosure (A) violates autonomy without due
process. Source: NSGC’s Decision-Making Model for Conflict
Resolution (2025).
Subdomain 5c: Professional Frameworks
Question 1
, A genetic counselor plans a quality improvement (QI) project to
reduce wait times for cancer risk assessments. Which resource
provides standardized metrics?
A) ACMG’s QI Metrics for Genetic Services
B) NSGC’s JEDI Competencies
C) Medicare’s CED Framework
D) FDA’s LDT Compliance Checklist
Answer: A) ACMG’s QI Metrics for Genetic Services
Rationale:
ACMG’s QI Metrics offer benchmarks for service efficiency and
patient outcomes, critical for QI projects.
JEDI Competencies (B) address equity, not operational
metrics. Source: ACMG QI Metrics for Genetic Services (2025).
Question 2
Under ACGC’s 2025 Scope of Practice Amendments, which activity
is NOW within a genetic counselor’s scope?
A) Prescribing pharmacogenomic-guided antidepressants.
B) Ordering diagnostic exome sequencing independently.
C) Performing venipuncture for genetic testing.
D) Supervising clinical trials for gene therapies.
Answer: B) Ordering diagnostic exome sequencing independently.
Rationale:
The 2025 amendments expand roles to include independent test
ordering in some states, though prescribing (A) remains outside
scope.
Source: ACGC’s 2025 Scope of Practice Amendments, Section
2.3.
