Sleep centers extends critical information on diagnostic testing details helping with a number of disorders with health conditions. Right from the cardiologists to the world of physicians, a huge chunk of physicians across several specialties has to depend on sleep studies for understanding many health conditions that lay hidden.

As these medical services are commonly prescribed, sleep study centers often face sudden increases in patient volume. Regularly fluctuating patient volumes make in-house sleep study billing challenging.

During times of high patient volume, admin staff at sleep centers rushes to complete insurance verification, prior authorization requests and other sleep test billing tasks on time, to not delay patient care.

This often increases errors in insurance & eligibility verification, billing, and coding. As a result of this, sleep centers lose a decent amount of their revenues every year. However, several industry surveys have suggested that most of the revenue loss for sleep centers is a result of about 25% of the sleep study billing errors.

Therefore to help sleep research centers identify top billing challenges and reduce billing errors, we will discuss some of the biggest challenges in sleep study billing that bring down revenues.

Insurance and coverage guidelines

Not all patients have insurance coverage. And the ones that have, may not be covered for all medical services. And that’s why, it is important to verify insurance and coverage benefits accurately before the delivery of medical services.

Documentation and medical necessity concerns

Errors in documentation and not establishing medical necessity are one of the most common reasons behind denials and rejections of PA requests. These denials inflate costs and cause delays. And so, sleep centers should ensure zero documentation & medical necessity errors to reduce delays and cut down expenses.

Prior authorization delays and challenges

Prior authorization is yet another major challenge in sleep study billing operations. To avoid PA-related delays and issues, sleep centers must hire staff experienced in this function and following an optimized operational process.

Complex sleep study billing & coding guidelines

Coding guidelines are complicated for all medical specialties. Coding for sleep testing procedures is no different. Most of the coding mistakes in sleep center billing operations are a result of inexperience or lack of knowledge of sleep center billing and coding guidelines.

These challenges make billing for sleep tests with multiple components even more difficult. These challenges become worse when there is a shortage of experienced and certified medical billers & coders.

The major advantage of working with a dedicated sleep study billing vendor will be getting a tangible roadmap to reduce proven flaws and focus more on your patients. It can change the way you are currently managing your overall practice management demands in the best possible manner.

However, practices can overcome these challenges by following a streamlined sleep study billing workflow. Doing so will help avoid difficulties in verifying insurance and coverage details, completing pre-authorization requests, and coding sleep tests accurately.

To learn more about our tried and tested sleep study billing best practices that can help your medical center avoid revenue losses, please contact Sunknowledge Services Inc, a HIPAA-compliant healthcare revenue cycle management organization serving US healthcare providers since 2007. Talk to our team and come to know how we intend to drive your growth priorities.