Why Sleep Study Billing Services Are in High Demand?

 

A sleep study is an overnight, non-invasive diagnostic test that monitors brain waves, heart rate, oxygen levels, and eye movements to diagnose various types of sleep disorders. It is mostly conducted in a special lab through the at-home kits that are available to test all aspects of obstructive sleep apnea. However, the billing process for sleep studies is a very complex affair, as it includes the usage of complex codes and modifiers. So, the solution to this problem is to outsource sleep study billing services that know all the complex nuances of the claim submission procedure.  

A major reason for the rise of sleep studies is the shift from all the in-lab sleep studies to the at-home tests. At-home tests are one of the most popular methods to diagnose sleep-related disorders. While all the in-lab tests have significantly declined, the overall number of tests performed at home has significantly increased. It means more claims, billing, and financial work for the clinics to keep up. The whole affair to manage the sleep study billing process has become an extremely complex procedure. A large number of sleep tests occur these days, and each test has different codes, documentation needs, and payer rules. But it has been observed that the billing process is a highly complex affair.  

Top 4 Billing Challenges Faced by Clinicians  

The billing challenges range from prior authorization failures to a lack of billing information visibility. Not solving any of these challenges can negatively impact the clinic’s revenue cycle. The challenges are:  

Prior Authorization Failures  

It is one of the major claim denial reasons for sleep study billing. You need to get the necessary prior authorization based on the patient’s medical documentation procedures, it can lead to denials. Apart from that, the other problem include when the doctors order test, and the sleep centers get the prior authorization approval from the insurer. In most cases, the clinics think the service is covered, but they end up with claim denials.  

Upcoding and Downcoding  

Overcoding occurs when you bill for the higher services that are not provided, and undercoding occurs when you bill for the lower services than the ones provided. The reason being the healthcare staff don’t have enough knowledge of the codes and modifiers used for all the services provided. For example, if you bill 95810 codes instead of 95811 or use the wrong modifiers such as –26 to –TC, it can significantly lead to claim denials.  

Mismanaging the Place of Service (POS) Codes  

Using the incorrect Place of Service codes or failing to distinguish between hospital and clinic outpatient settings can also lead to claim denials. Hence, knowing the right place of service codes is an important aspect for the clinic to enhance its cash flow.  

Lack of Billing Information Visibility  

The clinic creates a huge bill for the payer, but not all information are properly written. However, there’s no clear explanation for all the given charges. The medical bills are difficult to understand because not all services are coded correctly. Most of the times, the medical bills comes with codes and jargon without any kind of clear explanation, which create confusion and delay payment for the clinic.  

How Do the Outsourced Sleep Study Billing Services Help?  

The third-party companies stay updated with all the latest CPT, ICD, and HCPCS codes to make sure no claim denial occurs. Moreover, they also know all the complex nuances of the HIPAA law to protect patient data. These outsourced services also know all the complex nuances of the prior authorization procedure by verifying the patient’s insurance eligibility, collecting important documents, and then submitting prior authorization requests to make sure no issue occurs.  

The in-house staff is highly expensive because you need to train them and also buy an expensive office space for them. On the contrary, the outsourced experts are previously trained and don’t need any separate office space, which can reduce the clinic’s cost. They also know how to work with the clinic’s EHR system to store patient data and Electronic Prior Authorization procedures to submit claims electronically.  

These third-party services can reduce your operational costs by 80% and work with 10% buffer resources to make sure no issue occurs. Moreover, they also provide dedicated account managers and have no restrictive clauses or binding contracts. In addition to that, these companies also provide customized reports and the best infrastructure setup according to the client’s needs. In case any issue occurs from their side, they can help you with $1 million insurance coverage. 

Apart from sleep study, they also help with other specialties such as DME, gastroenterology, infusion, cardiology, and many more specialties. So, if you want to streamline your billing process, it can be a feasible option to outsource sleep study billing services in that matter. Hence, take the step today and see the difference.