Sleep Medicine Billing

Yes. All coding is performed by certified coders, and specialty assignment is deliberate rather than incidental — in-lab versus home sleep testing codes, and PAP device supply schedules billed on their own cadence.

Three causes account for most of it: in-lab study billed without a failed home study; pAP adherence not documented for continued coverage; supply replacement billed ahead of schedule. Each is a documentation or process failure rather than a coverage dispute, which is why we report denials grouped by cause instead of as a single rate.

Payers increasingly require a home study first, and continued device coverage depends on documented adherence data. That shapes which denials are worth appealing and where the front-end effort should sit, so it drives how we staff the work rather than being background color.

No. Payment is decided by the payer, and any firm promising a collection rate is describing something it does not control. We commit to the process and to six reported numbers you can check against your own system.

Codes are assigned from the documentation the practice provides, and where the record does not support a code we raise a query rather than infer intent. The clinical record and the certification of medical necessity remain the practice's, and claims go out under the provider's own National Provider Identifier.