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Sleep Studies - Your Worst Nightmare: New Billing and Compliance Issues


Sleep study procedures are defined by a limited set of CPT® codes. Documentation and coding guidelines, however, become complex when considering the medical necessity requirements for coverage and payment. In response to the rapid growth in requests for sleep studies, the industry has moved toward use of in-home technology to reduce cost. This move in sleep study technology adds to the list of CPT codes and documentation requirements of the billing entity.

Price: $229.00

Product Code: R092817


Description Biographies

In recent years, the performance of sleep study procedures has moved from in-house/attended polysomnography and CPAP titration to "at-home" unattended sleep study procedures. This shift in test methodology and setting helps to reduce overhead cost and dollars spent by Medicare and private insurers for this testing that is rapidly growing in utilization. As a result, there has also been an increase in requirements to support the need for attended studies resulting in compliance concern for ensuring documentation and coding accuracy. These changes in industry practice place sleep centers under scrutiny and at risk of external audit.

Most recently, Medicare Administrative Contractors (MAC) have implemented new requirements for staff credentialing and facility accreditation for sleep center locations (other than patient home).

All of the above has an impact on how sleep centers are reimbursed and can place the payments made at risk for recoupment if under audit it is determined that the sleep center is out of compliance.

The good news: This webcast will address the best practices for improving and protecting reimbursement of ordering providers as well as the provider that performs and bills for sleep procedures.

Learning Objectives:

From this session, you will learn...

  • The CPT codes and coding guidelines based on procedure setting
  • The documentation requirements to support the medical necessity of sleep studies
  • Best practice process for final coding of diagnosis
  • How to establish internal compliance measures
  • The recent regulatory changes impacting staff credentials and facility accreditation

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