Hypnogram: Sleep study coverage policies

One of the privileges of being AASM president is to receive frequent messages and comments from members. This feedback has helped me keep a finger on the pulse of the issues that concern my colleagues in the sleep field.  I take seriously the responsibility of evaluating this input and guiding the AASM to respond appropriately.

In recent months, I’ve received numerous comments from members regarding changes to their regional insurance coverage policies, which typically have involved new preauthorization requirements and utilization management review. While similar billing and reimbursement procedures have been common in other medical specialties for many years, their implementation for sleep study coverage has been a dramatic change for sleep physicians.

Anecdotal reports from some members suggest that these new policies have not always been implemented fairly and responsibly. The AASM responded by sending a letter to Cigna last month, demanding improvements to its OCST contracting and sleep testing preauthorization processes.  Earlier this week, the AASM sent a similar letter to MVP that challenged them to improve their OCST contracting.

The AASM understands that these issues are of critical importance to our members. Therefore, we need to gain a more comprehensive understanding of how preauthorization protocols are impacting our members throughout the nation. That is why the AASM recently sent all members a special message requesting the completion of a preauthorization survey. I urge you to complete this survey and return it to coding@aasm.org by the deadline of May 28.  Your input is of great value to us.

You can expect to receive much more information from the AASM in the weeks and months ahead about sleep study coverage policies and how the AASM is responding to them. We also are developing educational resources to help you and your staff understand how these changes affect your practice.

This subject will be one of the topics I will address during the AASM General Membership Meeting at SLEEP 2013 in Baltimore.  I hope you will join us for this meeting on Monday, June 3, from 12:30 p.m. to 1:45 p.m. in Room 343 of the Baltimore Convention Center.  I look forward to seeing you there.

Sincerely, 

Sam Fleishman, MD
President

2017-10-03T19:11:54+00:00 May 17th, 2013|Thought Leaders|