Lois McMaster
It takes several different skills to run a successful sleep study center. When you look at the business side of your practice, rules are the same when it comes to operational stability.
Managing the nuances of sleep study billing can feel like navigating a labyrinth. Starting from coding errors up to prior authorization hurdles these challenges hinder cash flow and AR days.
But wait. You are not alone!
Most of the sleep study practices across the country are struggling with the changing clinical and administrative protocols that are resulting in staff burnout, poor service quality and of course decreased revenue.
Identifying the Challenges of Sleep Study Billing
Now let’s discuss what we need to know to address the problem before we look at the solutions to billing issues. Here are some of the most common challenges:
Coding Errors: Sleep studies consist of detailed coding (such as CPT codes: 95810 and 95811). A minor error within the process can result in claim denials.
Insurance limitations: Coverage and benefits for sleep study vary widely across insurers and states making it difficult to navigate revenue challenges.
High AR days and cash flow issues: Excessive hold-up of reimbursement amount is a problem since it holds back your income, creating problems with operating flow.
Documentation gaps: Failure to complete or submit inadequate documentation leads to denial of claims.
Lack of prior authorization: Failing to obtain timely preauthorization puts your practice at risk of denied claims, delayed reimbursements and disrupted cash flow.
Inefficient denial management: The failure to follow up on the denied claims will actually cost your practice’s revenue. Furthermore, a lack of defined workflow to make corrections in denied claims often results in revenue loss.
Strategies to Eliminate Inconveniences of Sleep Study Billing
It only takes being proactive in billing to make a whole lot of difference. Implement these best practices to minimize errors and improve efficiency in your sleep study billing services:
1. Double-check coding accuracy
Expend resources educating your billing team concerning the latest ICD-10 and CPT codes to use in sleep studies. Regular internal audits can help you eliminate potential errors and chances of claim denials.
2. Keep abreast of claim submission guidelines
Establish a vast pool of insurance policies relating to sleep studies. It helps you know any emerging policy that may affect your payer thus prop the organization performs better.
3. Streamline documentation
Adhere to templates used for documentation in that they should capture all the requirements of the different payers. The internal medical record, physicians’ and technicians’ documentation, must be complete to prevent denials.
4. Prior authorization must be the first level of utilization review activity
It’s always good practice to check the coverage and obtain prior authorization before scheduling your patients. It is possible to automatically perform this action and eliminate a considerable amount of time spent on rejections.
5. Implementation of a denial management system
Properly assign a dedicated task force responsible for tracing, evaluating, and disputing the claims that have been denied. Employ the denial trends to get more accurate in billing.
Outsource for Efficiency: A Game Changer for Sleep Study Centers
When these best practices sound quite daunting, there is an even better way of handling this – outsourcing.
There are several organizations offering sleep study billing services who handle your practice’s financial aspects, and you can concentrate on patients. Here’s how outsourcing can help:
Expertise in sleep study billing: Outsourced teams today are informed on the specifics of coding, documentation and payer demands.
Faster claims processing: They keep claims clear of any contamination from other processes and hence exert pressure on AR days and increase cash flow.
Seamless denial management: Efficient teams translate to prompt handling of the cases and low chances of firms losing revenues through denial of claims.
Cost efficiency: Outsourcing your sleep study billing means no need for inside billing staff. This directly decreases the overhead expenses resulting in increased cash flow and optimized functionality of your practice.
The path to better sleep study billing efficiency is first to recognize the challenges and second, to adopt the correct approaches.
Whether you decide to launch in-house improvements or to work with a professional team, the idea remains the same – start today. As a reminder, every single claim that you deny is money out of the door; but by using the correct tactics, you can transform billing into victories.
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