How Sleep Study Billing Services Tackle Complex Modifiers

 

Sleep medicine plays an essential role in diagnosing all sleep-related issues. Though these sleep –related medications are important in patient care, billing for sleep studies are regarded as one of the toughest areas in medical billing. You need to know all the applied codes and payer rules to streamline your billing process. However, claim denials and tiny mistakes may lead to a quicker revenue loss for the clinics. That's why it can be a feasible option to outsource sleep study billing services in that matter. 

Describing Sleep Study Billing 

Sleep study monitors several physiological parameters in sleep. The reimbursement process starts with proper code selection, payor compliance, and documentation procedure. Hence, because of these reasons, you need to code precisely and follow all the payer’s payment needs to make sure clinics get timely payment. CMS has several code sets which are used based on several parameters. So, payers can deny claims when there is inaccurate CPT code selection.  

Factors Affecting Sleep Study Billing 

Unauthorized billing is one of the several factors due to which sleep study billing gets affected. Another factor is coding errors which happen when billing staff fails to distinguish between different sleep studies. Moreover, there are several difficulties occurring with split-night studies which need precise coding. The final two factors include claim denials and poor communication amongst billing teams. Hence, the solution to these problems is to build the structured workflows. Now, after the factors, you need to know the working process of modifiers. 

How Modifiers Work 

Modifiers are appended to the CPT or HCPCS level codes which provide extra information on the medical procedure, supply, and service involved in billing. Understanding when applying the modifiers is highly important. For example, if the clinic’s sleep lab bills both professional and technical components, then you don’t need any modifiers. So, if you can read the bills separately, it is very difficult to use the right modifier. Always remember that incorrect modifiers trigger audits, delay payments, and affect reimbursement heavily. 

What About Documentation and Payer Rules? 

In-depth documentation is essential to create an accurate medical claim. So, the sleep studies include following doctor’s order and documenting medical necessity, technician’s notes using start and stops and summary reports. That is how efficient sleep study billing services prevent documentation issues and follow payer rules. No two payers follow similar rules to get reimbursement for sleep studies. Medicare, commercial payers, and Medicaid use their own ways to make sure no claim denial occurs. A diagnostic sleep study is very easy to perform for the Medicare rules. Once the billing process is performed, no testing is allowed until the symptoms change. So, thorough documentation is highly beneficial to make sure no claim denial occurs. Always remember that even minor policy changes can delay your payments by several weeks. 

How Sleep Study Billing Services Work 

The outsourced companies have dedicated experts who know all the complex nuances of the ICD, CPT, and HCPCS codes to streamline the claim submission process. Apart from that, they also know the HIPAA law to protect patient data. These experts also streamline the PA process by verifying patient’s insurance eligibility, collecting important documents and then submitting PA requests to make sure no claim denial occurs.  

In addition to that, these outsourced RCM experts are highly cost-effective compared to the in-house team. It is because you need to train the in-house team and also buy expensive office space for them, which will incur a large amount of money. The outsourced companies have dedicated experts who stay updated with all the claim process. They also know how to work with the clinic’s EHR system and how to use the electronic prior authorization procedure to submit claims electronically. 

Delivering Excellence in Sleep Study Billing 

Sleep disorders affect around 70 to 80 million Americans in the US and billing for this process is very tough. Hence, it can be a good option to go for the outsourcing option. These outsourced companies can reduce your operational costs by 80% and 99.9% accuracy in charge entry, denial management and claim scrubbing. These RCM experts have a 97% first-pass rate and provide complimentary account managers at no extra cost. These companies provide custom reporting protocols and are thoroughly HIPAA compliant. They have no binding contract and restrictive clause and the best infrastructure setup according to the client’s needs. 

These experts also have dedicated employees with US phone numbers and less than two days of turnaround time. Apart from sleep study, these services also help with other specialties such as orthotics and prosthetics, gastroenterology, cardiology, infusion, DME, and many others. These companies have a comprehensive revenue cycle management and follow a proper coding process to make sure no issue occurs. Hence, if you want to streamline your billing process, it can be a good option to outsource sleep study billing services in that matter.