After receiving several inquiries from AASM members expressing concern that Blue Shield of California is denying reimbursement for positive airway pressure (PAP) therapy when a device with only one respiratory monitoring belt is used in performing the patient’s diagnostic sleep study, the AASM sent [...]
The AASM continues to advocate for prior authorization reform to allow clinicians to provide medically necessary care in a timely manner for patients with sleep disorders. Medicare Advantage organizations are currently at the forefront of national reform efforts, given recent studies and initiatives, by [...]
The AASM worked with the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS) to convert 12 phrenic nerve stimulation (PNS) Category III codes to Category I codes. The AMA Current Procedural Terminology (CPT) Editorial Panel accepted the addition of codes 3X008-3X015 [...]
Effective Jan. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) no longer requires Certificates of Medical Necessity and DME Information Forms for selected durable medical equipment (DME). This documentation was originally required to help confirm medical necessity and other coverage criteria. Historically, [...]
The Centers for Medicare & Medicaid Services (CMS) published the 2023 Physician Fee Schedule Final Rule in November. An analysis of the rule, including key highlights specific to sleep medicine, is included below. This analysis includes updated comparison documents to help sleep clinicians understand [...]
AASM staff, leadership and members, in coordination with AASM’s lobbying firm, McDermott+Consulting, have been working to resolve an urgent issue arising from an uptick in member audits involving claims for follow-up diagnostic sleep studies performed as required in local coverage determination policies. AASM members [...]
The AASM continues working toward a resolution for members in DME Jurisdiction D as they are reporting Medicare audits leading to claims denials due to seemingly conflicting language in two local coverage determination policies. The two LCDs include language regarding the medical necessity for [...]
As a part of the ongoing initiative to advocate for physician payment reform, the AASM has launched an online campaign to urge Congress to avert drastic reductions in physician payment in 2023. The AASM encourages you to send the campaign letter to your U.S. [...]
On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 proposed rule summarizing proposed revisions to the Medicare physician fee schedule (PFS) and Quality Payment Program (QPP). AASM’s health policy team performed an analysis of the proposed rule and [...]
Over the years, sleep medicine physicians have seen continuous reductions in reimbursements, not only because of decreases in physician work due to advances in technology, but largely due to lower conversion factors, budget neutrality, and implementation of payment adjustment sequestration. Diverting the Medicare physician [...]