SLEEP MEDICINE BILLING
How ProMedCL Helps Clinics Get Paid Faster for Sleep Medicine
Sleep medicine is a growing field, but it can be hard to get paid for. All sleep studies, CPAP titrations, and diagnosis codes must be correct in order to get paid quickly. Even a small mistake in the code can cause claims to be delayed or denied.
How to Figure Out Sleep Medicine Billing
It’s important to pay attention to the details and use the right CPT and ICD-10 codes when paying for sleep disorders. There should be a different way to charge for each patient’s illness, like sleep apnoea, insomnia, or narcolepsy. Before paying for sleep studies, insurance companies often check them out very carefully.
ProMedCL checks that every claim has the right medical necessity, provider notes, and payer standards. Claims are checked for mistakes before they are sent in. This makes it less likely that they will be turned down and more likely that they will be accepted. We keep an eye on what CMS and commercial payers are doing so that we know about any new rules for paying for sleep studies and durable medical equipment (DME) that go along with CPAP devices.
With our specialised sleep billing services, clinics can spend less time on paperwork and more time with patients. We focus on faster payments, following the rules, and managing the whole revenue cycle (RCM).
How to Code Sleep Studies Correctly
Correct coding leads to clean claims. For billing for sleep medicine, there are special CPT codes, like:
- 95810: Polysomnography with four or more parameters.
- 95811: Polysomnography with CPAP titration.
- 95806: A sleep study done at home that uses sensors to check how hard you are breathing.
- 94660: Beginning and running CPAP ventilation.
- 99213–99215: Appointments in the office or for follow-up for sleep issues.
- G0398–G0400: Medicare services for sleep studies.
- E0601: Code for charging for a CPAP machine.
- A7030–A7046: Things that go along with CPAP therapy.
ProMedCL’s licensed coders use ICD-10 codes like G47.33 for obstructive sleep apnoea and G47.00 for insomnia. Our billing experts make sure that every treatment code matches the right diagnosis so that claims don’t get turned down.
We also check the most recent CMS local coverage determinations (LCDs) to make sure they are in line with the payer’s medical policies. Claims are checked to make sure they are correct and follow the rules before they are sent in. For more info: https://promedcl.com/medical-coding-services/
News about CMS and Insurance
Recent changes to CMS billing make it even more important to keep accurate records for home sleep testing and CPAP compliance. Before they will pay for more therapy, payers want proof that the patient is following up. Reimbursement for diagnostic tests is based on a real medical need, not just what the patient wants.
Some private health insurance companies, like UnitedHealthcare, Aetna, and Cigna, have changed the rules for getting permission to have sleep tests. ProMedCL stays up to date on these policy changes to make sure they are following the rules. Our team quickly goes through payer bulletins and adds new tasks to your workflow.
Clinics can keep their cash flow steady and avoid having to pay back money or go through post-payment audits by focussing on following the rules.
What ProMedCL Does to Help
Every sleep practice has its own problems with billing, like getting permission ahead of time and having payers check their work. ProMedCL handles all aspects of billing for sleep medicine, including entering charges, submitting claims, making payments, dealing with denials, and reporting.
We work with EHR systems, sleep lab software, and clearinghouses to make things easier. Every month, reports are sent that show how claims are moving along, how revenue is coming in, and how often claims are being denied. We also help people with sleep problems get the right credentials, look over contracts, and check their insurance.
When practices choose ProMedCL, they get more accuracy, speed, and openness. We approve more claims, speed up the payment process, and make more money.
Why Use ProMedCL for Sleep Billing
- A lot of experience with billing for sleep studies and RCM.
- Certified coders who are experts in CPT, HCPCS, and ICD-10 coding.
- Reporting that is easy to understand and keeping track of claims in real time.
- Audits before submission to stop denial.
- Help with billing for DME and CPAP is available.
We want to help sleep clinics make more money, do less paperwork, and follow the rules. We can handle the complicated medical bills so you can focus on giving your patients better care.
Reliable Sources and Reference
To learn more about changes and requirements for sleep billing, check
Work with ProMedCL
At ProMedCL, we make sure that sleep medicine billing is correct, fast, and legal. We make sure that every claim is correct, every code is correct, and all the money is returned.
Call us today to learn how our billing services could help your clinic run more smoothly.