Sleep study billing is becoming more complex from time to time. You need to always stay updated on the latest changes as every new CMS rule affects your coding, reimbursements and provided telehealth process in your sleep study lab. Understanding these updates helps prevent errors, ensure compliance, and keep payments on track. You can always enjoy a seamless billing practice for your sleep study lab by clearly understanding the following updates coming from CMS. 

Critical updates in sleep study billing services that you must be aware of:  

New update on Medicare payment for somnologists: 

Medicare's payment system keeps changing, and it directly affects sleep study billing. The payment conversion factor has dropped to $32.3465, a 2.83% decrease from last year. This means lower reimbursements for both attended and unattended sleep studies. 

Lower payments make it harder for sleep centers to cover costs and maintain quality care. Your billing team should know how to stay on top of all these latest changes to avoid the loss of revenue. However, the good news for you is that the American Academy of Sleep Medicine (AASM) is strongly working on improving payments for somnologists, thus increasing the earning potential for your practice. You should always do your best to adapt all these updates to ensure the utmost financial stability for your sleep study lab. 

Recently updated HCPCS and CPT codes:  

Using the right HCPCS and CPT codes is the key to keeping your billing on track. Here are the latest coding updates you need to follow this year. 

  • CMS has updated the rules for code G2211. Now, you can get paid for G2211 even if it's billed on the same day as preventive care, annual wellness visits, or vaccinations. This is great news for somnologists like you. It means you can bill for these services without payment concerns. This update helps ensure fair reimbursement for the extra time and effort you spend managing patient care. With fewer restrictions, your practice can capture more revenue while delivering quality care.
  • CPT code 95800 has been flagged as invalid. More providers now use disposable equipment instead of reusable tools for unattended sleep studies. This shift has changed how sleep tests are conducted and billed. Fortunately, AASM is working its best and collaborating with other groups to come up with new codes to document unattended sleep testing. These updates will help sleep specialists bill correctly for modern technology and different sleep disorders.
  • CPT code 98016 replaces the old G2012 code. It covers quick phone or video consultations. Now, you can bill for brief assessments before scheduling a full sleep study.

The current telehealth policy changes:  

  • CMS has reinstated old telehealth rules. Now, only Medicare patients in specific areas, like rural regions or places with healthcare shortages, can access telehealth services. This limits care options for many patients. Without new laws, telehealth services for sleep studies will remain restricted. However, the AASM is backing efforts to expand telehealth access. They support legislation that aims to make telehealth more available for sleep specialists and patients. If passed, this would allow more people to receive virtual consultations, improving accessibility and continuity of care, thus increasing more patient volume and requiring you to focus more on establishing a perfect sleep study billing service.
  • A key update you should know is that audio-only calls are still allowed for Medicare telehealth services. This makes it easier to talk to patients remotely. It's especially helpful for initial consultations and follow-ups on sleep studies so that you can bill those services properly.

No wonder ensuring the perfect sleep study analysis is always your priority, but when you need to handle your billing part as well, things become really hard for you. It can be more challenging when staying updated with the latest CMS rules is highly crucial. The reality is that it is not only you who are feeling the heat, rather most somnologists feel overwhelmed keeping up with all the major changes rolled out by CMS. 

Fortunately, you can outsource the sleep study billing process as their experts know how to stay on top of the latest billing game and ensure the perfect cash flow for your sleep study lab. Let a professional RCM company manage your billing process so that you can focus on your sleep study practice. So, take your first step today and hire a perfect billing partner.