Top Challenges Sleep Labs Face without Professional Sleep Study Billing Services

Poor sleep is one of the concerning issues that affect millions of American people every night. We all know the fact that sleeps issues is more than just feeling dizzy after waking up. Sleeping issues are something that should not be taken lightly at any cost as these can manifest in various ways in your patients. Some of the issues are experiencing sleepless nights, seizure and breathing obstacles during sleep which is also known as sleep apnea. Do you know the number of people having sleep disorders? It is almost 50 to 70 million people and 1 in 3 adults do not even get to have uninterrupted sleep that they need for better health.

Now more patients are being referred to your sleep lab as the overall awareness grows. You might have already seen that number of sleep studies like home tests and in-lab polysomnography are rising significantly over the last few years. The truth is that you can only provide better care to your patients suffering from sleep issues when your financial side stays healthy. An efficient sleep study billing service is what always keeps your financial revenue foundation healthy. Now, you need to adhere to more payer rules, face more paperwork and errors with the growing demand for various sleep studies. Most sleep study practices experience hampered flow in patient care as they are already overwhelmed with handling all the pre and post-billing activities like patient eligibility verification, prior authorization, complex coding, claims submission, AR and denial management, etc.

The huge pressure of managing the billing job has already turned many healthcare practices to outsource their revenue cycle management services to professional billing companies.

A recently conducted 2024 poll by MGMA already revealed the fact that 36% of medical practice leaders were more likely to go for the option of outsourcing and many of them have already outsourced some components of their RCM. Sleep study labs are also not the exception to it. Are you feeling curious to know about the tendency behind outsourcing sleep study billing services? It is because there are multiple challenges come when a practice relies on their internal team to manage the whole game of billing.

Let’s know about the vital challenges of billing for sleep studies and how a professional company can help.

Related Reading: The Definitive Factsheet to Help in Sleep Study Billing

Major challenges of sleep study billing services to know about:

Complex coding:

You already know how crucial roles CPT codes play in your sleep study billing services as each code that you assign tells an insurance payer about exact services that you have provided. Here are some examples of commonly used CPT codes- you assign 95810 for describing a complete diagnostic Polysomnography and 95811 for documenting split-night studies or CPAP titration. Any small mistake in your coding process can cause your practice to face billing issues, claim denials and loss of payments. Another crucial issue that causes frequent errors is assigning wrong modifiers. You can face claim denial because of missing modifier 26 when you have provided a professional service, thus ending up delayed payments and wasted time. Sleep study labs with novice administrative team often become confused in navigating the difference between in-lab and at-home studies. You need to assign codes like 95810 and 95811 for defining in-lab services and use codes G0399 or 95800 for documenting HSAT. They often face monetary loss because of mixing them up by mistake. You cannot take bundling and unbundling services lightly as practices often face denied claims because of billing bundled services separately. It is always important to focus on careful coding to keep your billing process smooth and accurate.

Overwhelming documentation formalities:

Insurance payers have very strict requirement of providing proof that the sleep study services provided by you is medically necessary for your patient. You need to provide the Epworth Sleepiness Scale score where you need to show how sleepy your patient feels in daily situations like reading, watching TV or sitting without any work. You cannot afford to ignore the requirement of providing the insurance payer with the technician report that includes breathing pauses, snoring, or oxygen drops during the sleep studies. These details show the real medical necessity for the treatment. The physician note provided by you should include the accurate diagnosis code like G47.33 for OSA. Your practice is more likely to face claim denials if any of these details is missing, thus making it imperative for you to ensure a proper documentation process.

Prior authorization hassles:

Most insurance payers need PA before you perform vital sleep studies like CPAP titration or PSG. The insurance payers tend to deny claims if you submit a claim without a PA approval or get it after the specific timeline. Most practices face PA delays with 95811 or split-night studies. The insurance payers won’t even pay for a service which is medically necessary because of missing PA approval. A common mistake that you should be aware of is forgetting to check the authorization validity window that covers the exact date of service. Here is an example- you have received a PA approval granted for testing in October but you performed the study in November, you would end up with denial, caused by the issue called authorization span mismatch. You have to understand carefully that PA is not all about getting approvals but also making sure dates, codes and medical notes match in the perfect manner as any small error can lead your sleep lab to face financial loss.

Constantly changing payer rules:

The rules for sleep study billing services keep changing and Medicare, Medicaid and private payers have their own set of rules. CMS keeps its rules updated from time to time, making it really challenging for you to stay on top of all the billing rules when you do not have a dedicated billing team. Let’s go through an example of a latest CMS rule- your patient must complete a documented sleep study like PSG or HSAT and exhibit the clinical sleep apnea symptom. Your report must include vital findings like apnea-hypopnea index (AHI) and oxygen levels. You also need to prove that your patient has received the CPAP machine and being used by them on a regular basis. The reimbursement will be denied if you fail to provide the proof. Compliance is not a one-time effort as you need to adhere to it all the time.

Fortunately, a professional sleep study billing service provider like SunKnowledge can help you avoid all the challenges mentioned above as they know what it takes to stay on top of your billing game.

Related Reading: The Ultimate Guide to Sleep Study Billing

SunKnowledge: The perfect sleep study billing service provider

We offer you the end-to-end sleep study billing services covering all the steps in your process. Our experts always verify patient benefits in real-time, check in-network statuses, deductibles, copays, coinsurance and secure timely prior authorization. We also gather immediate clinical notes and referrals. We reduce your billing and collection costs by up to 80% and maintain a 97% first-pass rate, while also offering complimentary account managers and custom reporting with no binding contracts. Your staff always stays away from administrative headaches, reimbursements become faster and denials go down significantly with our sleep study billing services at $7/hour!