Sleep medicine is one of the rarer specialties in the healthcare industry that’s growing in popularity. As the name suggests, sleep medicine is a subdivision of healthcare that deals with handling sleep disorders and related issues. Sleep disorders could be the starting point for other health conditions in patients. Conversely, certain health conditions can lead to sleep issues like insomnia or sleep apnea.
That is why this is a very complex segment, with equally challenging backend processes. Not all medical billing and coding companies agree to take up sleep medicine clients because treatment may involve the use of multiple experts, services, and processes.
For instance, some sleep doctors could be neurologists, and the treatment they offer may align with neurological specifications. Other doctors who offer sleep medicine services call themselves somnologists and believe in a different approach/treatment plan for their patients. In addition, doctors with a variety of other specializations like pediatricians, cardiologists, and psychiatrists may also offer sleep medicine services as a part of their treatment plan.
This makes the work of medical billing and coding companies even more complicated. As their client, you will lose considerable money if they miss out on adding a particular service or end up with claim denials if they add the wrong codes/modifiers.
There are different equipment and diagnostic tools that the sleep medicine practice uses. Some of them include polysomnography tests, non-polysomnography tests, home sleep study tests, and actigraphy tests.
Here are the coding challenges that are faced with sleep medicine. The codes and the modifiers are going to change with each test. The number of parameters monitored in the test or the number of hours the test ran are all factors that the coders need to verify before using a code and/or a modifier. That sounds challenging, doesn’t it?
For instance, if a test ran for more than six hours, the coder should not use the modifier 52. However, if the patient is younger than six years, the modifier 52 should not be appended only if the test ran for more than seven hours. See the challenge?
Now, the coders must know both the CPT and HCPCS codes for sleep medicine clients. While the Level I HCPCS codes are similar to CPT ones, the Level II codes are created for non-physician services and can be used only by coders who are adept at understanding them. While choosing third-party medical billing and coding companies to handle your backend RCM services, make sure to check if their coders have prior experience working with level II HCPCS codes.
The need to stay updated
Apart from having to deal with complexities in sleep medicine coding, the general struggle of wading through the ever-changing guidelines of medical billing and coding is something to consider a challenge. This is an industry where change is frequent and unavoidable. Billers and coders have to be on their feet, constantly taking new training, understanding new technological advancements in the industry, and generally being updated. So, unless these medical billing and coding companies make the efforts to provide their employees with a great learning and development platform, they may not be able to perform adequately.
Depending too much on manual systems
This is a mistake that medical billing and coding companies can make without realizing the long-term effect it may have. There are a lot of steps involved in the billing and coding process. From extracting data from the patient records to capturing the treatment notes, using the right codes, making the correct decisions on different claims, and submitting claims on time, the processes are all interdependent and vital for a claim to be successfully reimbursed.
When these processes are not backed technologically, errors are inevitable. The slightest error in one step can affect the others following it.
Technology is a lifesaver in such situations. Quintessence uses Artificial Intelligence to automate most of the billing and coding processes. For instance, our reimbursement tool is designed to make the right decisions on each claim and nudge billers to take the correct actions. The tool provides data like the number of touches to closure and helps avoid avoidable AR follow-ups that waste time and resources.
Our coding tool, Codessence, is a Machine Learning piece of wonder that learns with every code and helps coders avoid guessing and precisely entering codes and append modifiers. This code can be tweaked to handle changing guidelines and specific audit requirements that medical billing and coding companies encounter.
Trying to do everything in-house
As a sleep medicine expert, here is something that you may be doing that’s affecting your practice. Many private practitioners always work on limited budgets and, as a result, try getting everything done in-house. If you are a healthcare provider with a medical billing and coding team handling the rest of the practices, you cannot expect them to do the same quality job as sleep medicine. Make sure the team has prior experience in this field. Otherwise, it would make sense to outsource the process to medical billing and coding companies that come with a background in handling sleep medicine practices.
Otherwise, your team wouldn’t be optimally moving claims to reimbursements, and you will be losing the money that the practice deserves.
If you are a doctor starting up your practice now, it is also smart to consider hiring third-party medical billing and coding companies instead of getting your own team in-house. Here are the reasons why.
Working with a brand like Quintessence early when you start up will help you in many ways. You get to work with the best billing and coding experts in the country and access all the high-end tools and software. Medical billing and coding companies like us consider clients like you our working partners. As a result, we do more than just billing and coding. We take equal responsibility for your growth and work on putting your brand on top of the map.
If you are a sleep medicine expert or have a client in this segment, then Quintessence could be the advantage you have been looking for. Give us a call to understand how best our solutions would work for you.