Sleep Medicine billing and accounts receivable

Attended polysomnography, home sleep testing, PAP titration and the interpretation that follows are only half the work. The same patient then produces a device claim and a monthly supply claim, often sitting under a separate benefit, a separate authorization and a separate supplier network.

Where the money leaks in sleep medicine

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• In-lab polysomnography denied because the chart never records why a home sleep test was unsuitable for this patient
• Split-night study downcoded to a diagnostic study because the report never records when titration began or what prompted the switch
• Continued PAP rental denied because the adherence download and the re-evaluation visit were not on file inside the plan's compliance window
• Mask, cushion and tubing resupply shipped on a standing schedule with nothing on file confirming the patient still uses the device and needed replacements
• PAP device supplied in-house and denied because the plan carves equipment out to a contracted supplier network the practice does not belong to
• Multiple sleep latency testing billed with no preceding overnight study, sleep diary or medication washout recorded in the chart

What a seat does about it

One trained person works your queue from the difficult end, from our office in Rawalpindi, Pakistan, logged into your own system on your hours. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — check yours before placing a restricted queue on this seat (more on /security/).

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and medical coding at $2,500, on request.

Questions