The sleep medicine industry in the US is going through a dubious enigma. The industry is projected to grow from $9.20 billion in 2021 to $15.92 billion in 2028 while the revenue of the sleep study clinics declined at a CAGR of 1 percent in the last five years. This situation puts a question mark on the effectiveness of sleep study billing and coding services. Furthermore, this entails a threat to the revenue machinery of every sleep medicine service. The grappling challenges of prior authorization, convoluted eligibility rules and uncertainty regarding reimbursements are often the culprits of crippling sleep study billing practices, increased workloads and staff burnouts.
Major Threats in Sleep Study Billing
- Complex prior authorization: Payors use prior authorization in sleep study billing works as a cost controlling tactic. So that the services are rendered only when there is a medical necessity. When it is the same for most medical services, delayed authorization results in disrupted patient care and increased administrative burden on you. A survey by AMA showed that 88 percent of healthcare providers said that PA adds more burden to their already busy schedule. If you are one of them, then you must agree that uncertainty regarding the treatment approval creates an additional obstacle within the treatment process as well as financial stability of your practice.
Intricacies in prior authorization elevates the complexities in sleep disorder diagnoses and treatments along with negative impacts on healthcare costs. For instance, a patient with sleep apnea requires CPAP that costs several thousand dollars. However, the delay in treatment can lead to adverse health outcomes and more costs. On top of that, different insurance companies have different rules for approval of similar treatments. This makes the sleep study billing complicated and makes the process more tedious for you. - Low reimbursement rates: Accurate and timely reimbursements are crucial for financial stability and functionality of sleep study practices. However, payors have significant bargaining power when it comes to sleep study revenue. This results in lower reimbursements and revenue compared to the services rendered. Additionally, location and population density directly affect the revenue of sleep study clinics. Where sleep facilities in urban areas struggle with labor shortage, rural independent sleep centers suffer from low negotiation powers when establishing contracts with payors.
This factor intensifies the problem that sleep study centers typically operate on a low profit margin. In this scenario, you have to spend your revenue on staff salaries, overhead expenses and expensive equipment. - Outdated technology: Despise of advanced technologies and digitization processes of sleep study billing, some facilities have not implemented those. From lack of automation within the billing and coding process to lack of communication with payors boils down to reduced revenue of sleep study practices. You need to establish a proper communication channel to maintain contact with the payors and leverage the technology benefits to automate the billing workflow.
Take a Step Ahead
Sleep study billing and coding process is quite intricate and you need defined process to overcome the challenges of the same. These challenges become worse when there is a shortage of experienced medical billers and coders. To overcome these issues, you can partner up with an RCM organization that will drive your revenue. A team of professional medical billers and coders understands the intricacies of coding and billing for sleep study and has detailed understanding of payors’ norms and regulations. Furthermore, experienced medical billers and coders can maintain effective communication with the payors regarding the prior authorization and other intricacies within the sleep study coding and billing. Also, these experts are well-versed in advanced technology and data integrity, hence automation of the process will not be a matter of concern. You can leverage the expertise of an outsourced RCM team, which will allow you to focus on quality services and reduce the burden of administrative tasks in the long run.
Sunknowledge Services Inc. – an ISO 27001:2022 certified, American-owned & operated company, headquartered in New York City – is a leading global provider of Business and Knowledge Process Outsourcing services in the US healthcare domain.
