Patient Acceptance Fact Sheet

Applicable Accreditation Standards

Entities must maintain a Policy and Procedures Manual that addresses patient acceptance policies for sleep clinics, in-lab testing, HSAT and DME. Written policies for patient acceptance must include:

  • Adherence to all applicable, current AASM guidelines
  • Age limitations.
  • A mechanism for acceptance.
  • Evidence based criteria for exclusion; and
  • Information required from a referring health care provider prior to all sleep testing.

The Sleep Clinic must be able to evaluate, manage and provide follow-up for an adequate range of sleep disorders (as defined in Standard C-1) Sleep Clinic(s) associated with diagnostic services (In-lab and/or HSAT) must accept all patients at the diagnostic service location(s).

Body Space Before”,201340122,”2″,134234082,”true”,134233614,”true”,469778129,”Body-BodySpaceBefore”,335572020,”1″,335559738,”180″,469778324,”Normal”]}”>Each location providing in-lab testing services must be able to provide diagnostic sleep testing for all sleep disorders requiring lab-based testing for diagnosis (including but not limited to central sleep apnea, parasomnia and central hypersomnia).

Body Copy”,201340122,”2″,134234082,”true”,134233614,”true”,469778129,”Body-BodyCopy”,335572020,”1″,469777841,”Arial”,469777842,”Arial”,469777843,”Times New Roman”,469777844,”Arial”,469769226,”Arial,Times New Roman”,335559740,”280″,201341983,”1″,335559739,”270″,201342446,”1″,201342447,”5″,201342448,”1″,201342449,”1″,201341986,”1″,268442635,”22″]}”>For patients directly referred, the medical staff member or appropriately trained technical or administrative support staff member must review the information provided for each patient and determine if the requested action is indicated according to the component’s patient acceptance policy.  Evidence of communication with the referring clinician should be recorded in the patient record for every PSG or HSAT. This should include a history and physical received from the referring clinician and a sleep study report sent back to the referring clinician.

Sleep clinics must document in the medical record ongoing evaluation, management, and follow-up of each patient with sleep disorders. Sleep Clinics must be able to show medical records to demonstrate management of an adequate range of sleep disorders. All sleep disorders are defined by the current edition of the international classification of Sleep Disorders.

Patient Acceptance Policy

Explicit acceptance criteria for defining the patient population at each service location ensure that all evaluations are within the scope of professional expertise, technical competence, staff capability, and are appropriate for the service location.

Requirements for Clinic, In-Lab Testing, HSAT Services

This policy should be comprehensive and describe:

  • Adherence to all current AASM guidelines.
  • Age limitations.
  • Explanation of how referrals are received.
  • Evidence-based criteria that may exclude a patient (e.g., infectious disease, weight limitation, etc.).
  • Information required from referring physician for patients directly referred.
    • Include a statement if direct referrals are not accepted
  • The process and procedure for reviewing and approving patient information to ensure the test is appropriate for the patient.

Requirements Specific for HSAT

The HSAT policy should clearly define:

  • HSAT should only be used for patients with a high pre-test probability of OSA.
  • It is not appropriate for patients under the age of 18. 
  • Evidence based criteria for exclusion, which may include:
    • Limited co-morbidities such as moderate to severe pulmonary disease, neuromuscular conditions, congestive heart failure, or other sleep disorders like central sleep apnea, periodic leg movement disorder (PLMD), circadian rhythm disorder (CRD), narcolepsy, and parasomnias.
    • HSAT should not be used for general screening. 

Definition: Direct Referrals

Directly referred patients are those who have not been seen in consultation by a sleep medical staff member either before or within three months following an in-lab sleep study or HSAT initially ordered by a referring physician.  

Key Things to Keep In Mind

  • The sleep clinic must be capable of evaluating and managing an adequate range of sleep disorders as defined in the most current ICSD manual.
  • Sleep clinics associated with diagnostic services (In-Lab and/or HSAT) must accept all patients tested at the diagnostic service location.
  • In-Lab testing service locations must provide diagnostic testing for all sleep disorders requiring lab-based diagnosis, including but not limited to central sleep apnea, obstructive apnea, parasomnia, and central hypersomnia. 
  • A medical staff member or appropriately trained technical or administrative support member must review the information for patients directly referred to determine if the acceptance criteria defined by the service location is met.  
  • The policy should outline the procedure for documenting the approval of direct referrals. 
  • Any communication with the referring clinician is to be maintained in the patient’s medical record.  
  • The HSAT acceptance policy should explain the rationale for accepting HSAT patients when AASM guidelines are not applied, such as cases involving insurance mandates, other medical reasons, or medical exceptions.