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What you need to know to get paid
Many respiratory therapy departments and hospital-based sleep centers do not understand how all the reimbursement pieces for outpatient sleep studies fit together especially the rules pertaining to medical necessity. This MedLearn book walks you through the intricacies of coding and compliance, helping you arrive at the full appropriate reimbursement. Highlights:
- Comprehensive list of ICD-9 sleep-related diagnosis codes, along with tips for their proper application; includes a crosswalk to applicable ICD-10 codes
- Explanation of Medicare national coverage policies for sleep disorders
- How to interpret the official guidelines for achieving consistently accurate CPT code assignments, proper modifier usage and clean bills
- The information required to support medical necessity, along with tips for avoiding other issues which can lead to payment denial
- Advance beneficiary notice (ABN) key requirements and usage guidelines
- How your revenue may be affected by coverage of home sleep testing
- Special section for each CPT code assignable for sleep-related services, including indications for use, billing tips, CCI edit tables and 2012 APC payment tables
- NEW FOR 2012:
- Summary of the most recent Office of the Inspector General (OIG) advisory opinions pertaining to sleep studies and the contractual relationship between sleep study providers and hospitals
Findings from MedLearn consulting experts
MedLearn publications address your real-world challenges and concerns, including the following examples shared by our consulting experts.
OIG work plan Polysomnography represents a growing revenue source for hospitals, independent diagnostic testing facilities and physician practices. A word of caution, however: In its updated 2012 work plan, the OIG includes review of sleep study procedures, particularly related to Medicare criteria for medical necessity and documentation. And, if the OIG is watching, providers should be aware that other auditors (RACs, MACs and MICs) aren’t far behind.
CPT is a registered trademark of the American Medical Association.
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