A Resourceful Manual of Sleep Study Billing Services

 

According to the research conducted by the American Academy of Sleep Medicine, about 25 million US adults have obstructive sleep apnea or OSA, with a large number of whom are undiagnosed and have not received treatment. Polysomnography or sleep studies are typically used to diagnose OSA and other sleep disorders, and they can be challenging for both parties, be it patients and healthcare providers.

There may be insurance coverage options that leave patients to continue with patchwork billing policies, even though the health risks of unaddressed OSA are great. However, sleep study billing services come with a lot of challenges. With a complex procedure, managing a seamless practice can be a real challenge if you lack a basic understanding. 

What do you understand by Sleep Study?   

A sleep study is an overnight test that watches your brain and body when you sleep. Doctors use the survey to detect any abnormalities in your sleeping patterns, and they determine factors such as the level of oxygen in your blood and your heart rate. It is a sleep lab study, and it takes a non-invasive procedure. The data will be collected by a technologist, who will later analyze it for your doctor. You will visit your doctor after approximately two weeks of the study to discuss the results.

The expenses on a sleep study will vary depending on the type of test and the service facility. However, if a sleep study clinic needs proper reimbursement, it has to follow the precise billing process and structure.  

Understanding the Insurance Coverage on Sleep Studies 

Your insurance plan will determine the amount of money that your payer will reimburse. You must call your insurance company to know whether a sleep study is covered under your policy. Depending upon the patient's insurance policy, as well as the actual diagnostic test conducted, insurance coverage on sleep studies differs.  Moreover, it is essential to understand the types of standard insurance coverage available for sleep studies, including Medicare, Medicaid, and private health insurance.

Polysomnography is typically covered by Medicare for patients who meet specific criteria. Healthcare plans also exist in the private health insurance sector, where they may cover such tests; however, coverage requirements and eligibility conditions differ significantly according to the patient's healthcare program.

Thus, it is essential to thoroughly review the specific coverage requirements of a patient's insurance policy. It will help them determine whether the insurance will cover the sleep study and reduce the patient's out-of-pocket expense. Healthcare providers also need to liaise closely with insurance firms to obtain pre-approval, enabling them to deliver prompt reimbursement of services.

The Billing Process for Polysomnography and Sleep Studies   

Here we will discuss the common procedure for sleep study billing. It is essential to note that outsourcing sleep study billing services is a great option to reduce overhead costs, enhance patient experience and the practice's reputation, and improve cash flow, resulting in better revenue. As with the right RCM experts following the billing process, you can do wonders starting from- 

Submitting claims - The outsourcing expert should send claims to the insurance companies or government schemes to charge consumers for sleep studies. These claims are normally supposed to be accompanied by the correct diagnosis as well as procedure codes, along with the documentation.   

Coding - When health care professionals charge for polysomnography or sleep tests, they have to assign the proper codes. The most popular codes are Current Procedural Terminology (CPT) and International Classification of Diseases (ICD).   

Supporting documentation - The RCM professionals should present all the requirements at the time of filing the claims of polysomnography, including medical records, test results, and referral forms.   

Sleep study billing is a complicated business. One must know that the price of a sleep study also depends upon the kind of testing being done and the center where the service is being offered. Last but not least, one can contact his or her insurance provider to learn whether their policy covers the sleep study and whether it is possible to appeal the refusal to cover the cost of the sleep study.