Author: Jim Mikes
Vice President of Rural Advocacy and Regulation
The Institute of Medicine and Centers for Disease Control and Prevention have highlighted sleep disorders as an important public health issue. According to a study commissioned by the American Academy of Sleep Medicine, in the U.S., 23.5 million adults suffer from obstructive sleep apnea without a clinical diagnosis. The resulting economic impact is estimated at almost $150 billion per year.
Hospital-based sleep labs play an important role in securing diagnoses and developing treatment plans for patients suffering from sleep disorders. Polysomnography, a diagnostic test that includes the recording of brain waves, muscle movements, oxygen levels and heart rate during sleep, is covered by Medicare when certain conditions are met. Medicare pays for polysomnography for patients exhibiting specific symptoms when the testing is performed by credentialed clinicians in accredited sleep labs.
Medicare pays for services through a Medicare Administrative Contractor. The MAC for Missouri hospitals is Wisconsin Physicians Services. The MAC has the authority to specify under what conditions providers can receive Medicare payments by issuing local coverage determinations. WPS recently updated its policy on polysomnography and other sleep studies to require hospital sleep labs to obtain sleep-specific accreditation from one of three acceptable organizations. Hospital sleep labs are required to be accredited by either the American Academy of Sleep Medicine, the Accreditation Commission for Health Care or The Joint Commission Ambulatory Care to file claims on Medicare beneficiaries.
Medicare payment policies are often confusing. As part of our ongoing advocacy efforts, MHA has worked with WPS and the Centers for Medicare & Medicaid Services to clarify the existing sleep lab policy and allow sleep labs in The Joint Commission-accredited hospitals to file Medicare claims while awaiting the sleep specific TJC ambulatory care accreditation.