On April 14, 2026, the Centers for Medicare & Medicaid Services (CMS) published the Interoperability Standards and Prior Authorization for Drugs Proposed Rule, representing a significant step toward modernizing prior authorization processes and expanding interoperability across the healthcare system. These efforts directly affect sleep [...]
A new legislative proposal was submitted to the U.S. Senate Finance Committee and the Centers for Medicare & Medicaid Services by the American Medical Association to reform the current Merit-based Incentive Payment System (MIPS) and transition to a redesigned program called the Data-Driven [...]
States and professional organizations are increasingly challenging private insurers' downcoding of evaluation and management (E/M) services, a practice clinicians say undermines physician judgment and delays appropriate reimbursement. E/M downcoding occurs when payers automatically reduce the level of a clinician-reported E/M code, resulting in [...]
The American Academy of Sleep Medicine recently sent a letter to UnitedHealthcare, raising concerns about the use of Synapse Health for durable medical equipment (DME) fulfillment for CPAP therapy. The letter outlined member‑reported issues affecting patient access to care and clinical workflows. AASM [...]
The American Academy of Sleep Medicine recently sent a letter to Wellmark to raise concerns about a payer policy affecting reimbursement for in-lab diagnostic and titration sleep studies. The policy restricts reimbursement for Current Procedural Terminology (CPT) codes 95810 (diagnostic polysomnography) and 95811 (polysomnography with PAP titration) when [...]
On Feb. 25, 2026, the Centers for Medicare & Medicaid Services (CMS) hosted the 2026 CMS Burden Reduction Conference, uniting stakeholders in person and virtually for a focused discussion on minimizing administrative burden across the health care sector. The panel addressed transparency in [...]
Centers for Medicare & Medicaid Services (CMS) have acknowledged stakeholder questions regarding the appropriate coding for hypoglossal nerve neurostimulator procedures used to treat obstructive sleep apnea. Specifically, CMS recognized that existing Current Procedural Terminology (CPT) codes do not fully describe certain newer systems. [...]
On Feb. 27, the Centers for Medicare & Medicaid Services (CMS) published a notice announcing a nationwide, six-month moratorium on the enrollment of new durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers in Medicare. The moratorium, effective immediately, is intended to help [...]
As part of the Consolidated Appropriations Act, 2026, which ended the recent partial government shutdown, Congress extended several Medicare telehealth flexibilities through Dec. 31, 2027. These policies, originally introduced during the COVID-19 public health emergency, were set to expire Jan. 30, 2026. The [...]
After advocacy efforts by the American Academy of Sleep Medicine and other medical organizations, UnitedHealthcare has announced a delay in implementing its remote patient monitoring policy. The AASM recently submitted a letter to UnitedHealthcare opposing its new remote patient monitoring policy and the [...]