You Won’t Find Us Asleep at the Wheel
by Michael Snyder, HNE Contract and Reimbursment Manager

The public profile of sleep disorders, such as Obstructive Sleep Apnea (OSA) and Excessive Daytime Sleepiness (EDS), has been raised recently by increased media attention.  For example, current research demonstrating correlations between OSA and hypertension, daytime sleepiness and accidents, and other disorders of sleep or sleep-related breathing that impact our well-being is often reported in the news.  

Studies have shown that demand has outpaced capacity for sleep testing in the country, particularly in Western Massachusetts.  Lengthy wait times for sleep studies have been reported.  As a result, many local, regional and national providers of sleep-related diagnostic testing have applied to participate in HNE’s network.  Currently, many of HNE’s contracted hospitals already provide overnight sleep testing.  Applicants have included private sleep-testing facilities, facilities still in the blueprint stage, facilities temporarily residing in hotels until more permanent accommodations can be acquired, and providers of home sleep monitoring.  

Overnight sleep testing is expensive and, if unmanaged, may be over-utilized.  In order to better manage the medical appropriateness of studies performed, as well as the qualifications of the many and varied applicants seeking to participate in HNE’s sleep network, HNE developed guidelines for provider participation, as well as for clinically appropriate testing.

As a result, HNE has implemented several policy and coverage changes.  First, HNE is requiring our contracted providers of sleep disorders testing to become accredited by the American Academy of Sleep Medicine (AASM) by January 1, 2008.  By requiring its providers to pass this comprehensive accreditation process, HNE is assuring consistency in the standards and protocols of sleep-testing facilities, as well as the level of training and certification of sleep physicians and technologists.    

Because HNE is confident that providers who have been accredited by AASM are providing appropriate testing, we will not require prior approval.  Since many providers are seeking AASM accreditation across the nation, if this results in delays in accreditation, HNE will allow contracted providers with AASM Provisional Accreditation status to continue to perform studies for our members through June 30, 2008.

Since it will be a full year before the benefits of the accredited network are realized, beginning January 1, 2007, HNE will not cover sleep studies that do not record EEGs (CPT codes 95806 and 95807), which is necessary to differentiate sleep from wakefulness and to determine sleep stages.  This is consistent with AASM guidelines.  

HNE believes its members can sleep better knowing that HNE has taken steps to improve the quality and consistency of sleep diagnostic testing in its network.