What are the different types of sleep centers that offer diagnostic testing for sleep disorders and what are the benefits of each?
What is an IDTF?
An IDTF is a diagnostic testing facility (entity) that is independent of a physician office or hospital; ie, it is not owned by a hospital, individual physician or group practice of physicians and its purpose is to furnish diagnostic tests and not to directly use test results to treat a patient.
The IDTF sleep center must provide for a supervising physician responsible for direct and ongoing oversight of the quality of the polysomnography (sleep study) test performed, proper operation and calibration of any equipment, the qualification of non physician personnel to operate such equipment, and supervision of those non physician personnel. The supervising physician must perform a general level of supervision over the operations of non physician personnel (click these links to learn more about sleep disorders and the types of studies used to diagnose them).
- The supervising physician may not order sleep studies to be performed by the IDTF, unless the IDTF’s supervising physician is, in fact, the Medicare beneficiary’s treating physician.
- An IDTF must be surveyed and approved by the Centers for Medicare and Medicaid Services (CMS) and will have it’s own Medicare provider number.
- An IDTF located somewhere other than in a hospital building cannot share office space or equipment with a physician, physician practice or other entity. It must remain independent.
The benefits of working with an IDTF sleep center:
- Sleep centers that are set up as IDTFs and are not limited by more strict accreditation guidelines (read more about voluntary accreditation standards for sleep centers below) and may have more flexibility in providing services as requested by ordering physicians.
- A large network of sleep centers, which is more likely to be an IDTF, may have more leverage from economies of scale when contracting with insurance companies and may therefore have more insurance contracts.
Things to consider:
- If an IDTF provides your sleep study, typically, the supervising physician or interpreting physician may not provide a prescription for recommended therapy, like CPAP, or engage in discussion about treatment or next steps with the patient. This is the responsibility of the referring physician (in some cases, the referring physician may also interpret the sleep study).
What is a hospital-based sleep center and who is it best for?
Hospitals and health systems have historically established sleep labs within the hospital or on the hospital’s campus. Most hospital-based sleep labs have been structured as part of the hospital’s outpatient department or outpatient programs, and sleep studies are billed under the hospital’s outpatient provider number and under the Outpatient Prospective Payment System (OPPS) for Medicare patients.
The benefits of working with a hospital-based sleep center:
- Increasingly, hospital-based sleep centers are able to provide services for Medicaid patients, whereas physician-run sleep centers or IDTFs may not be contracted.
- This type of environment may be best for patients with more severe medical conditions or very young children who require one-on-one attention from healthcare providers and may need special equipment.
Things to consider:
- A hospital-based sleep center may have the look and feel of a typical hospital room or it may be designed to look more like a hotel room.
- A hospital-based sleep center may have a long wait-time for appointments due to high demand and limited facilities.
- Depending on the set-up of the sleep center, sleep studies may be interpreted by a physician that can also see you for consultation, or by an independent physician.
What are the benefits of a physician-run sleep center?
Physicians who specialize in sleep medicine and may provide diagnostic sleep testing as an extension of their medical practice. Typically, the sleep center is structured as an extension of a physician’s practice. All sleep services are provided by the physician and the practice’s staff and the sleep studies and interpretations are billed under the practice’s provider number. Sometimes a physician will partner with a management company who may provide the equipment and assist with billing.
The benefits of working with a physician-run sleep center:
- Patients can usually see the physician in consultation before and after the sleep study, if needed.
- The patient does not need to be referred to another provider for the service. Scheduling, insurance authorizations, etc. are handled by the physician’s office.
Things to consider:
- Typically, a physician will operate a small sleep center near or within an existing practice. Some physicians use the same rooms for sleep studies that are used as exam rooms during the day. This is convenient for some patients as they are already familiar with the office (location and parking, etc.) but may not have the amenities of a free-standing sleep center.
- Physicians may or may not be contracted (in-network) with insurance companies to provide sleep studies for their patients. This may mean higher out-of-pocket cost for patients or no coverage at all (learn more about in-network vs. out-of-network coverage here)
Different types of voluntary accreditation standards for sleep centers
It is important to make sure that the sleep center you refer to (or are referred to by your doctor or medical group) meets state standards for healthcare facilities. Additionally, there are different types of voluntary accreditations that can be obtained by sleep centers, depending on the structure of the sleep center (physician-run vs. independent) and the type of services provided. In California, most insurance companies do not require that sleep centers meet AASM or Joint Commission standards, but many require that they meet Medicare requirements.
The Joint Commission
The Joint Commission, formerly known as JAHCO, is an independent not-for-profit organization which provides accreditation to over 21,000 healthcare organization across the U.S., including both sleep centers and providers of PAP therapy (learn more about CPAP therapy to treat sleep apnea here). The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. To earn and maintain The Joint Commission’s Gold Seal of Approval®, an organization undergoes an on-site survey by a Joint Commission survey team at least every three years.
Here’s a link to the Joint Commission site.
AASM Sleep Center Accreditation
Established in 1975 as the Association of Sleep Disorders Centers, the American Academy of Sleep Medicine (AASM) is the only professional society dedicated exclusively to the medical subspecialty of sleep medicine.The AASM has a combined membership of 11,000 accredited member sleep centers and individual members, including physicians, scientists and other health care professionals.
Since 1977, the AASM has accredited sleep facilities utilizing the AASM Standards for Accreditation of Sleep Disorders Centers. More than 2,500 sleep centers have achieved accreditation through the AASM.
AASM Standards for Accreditation of Sleep Disorders Centers includes requirements such as having a board-certified sleep specialist review the information provided for all patients to evaluate for potential sleep disorders before proceeding with testing and limits to the number of patients that can be studied at one time per technologist.
Here’s a link to the AASM accreditation standards.
Medicare Standards
Medicare administrative contractors (MACs) and the Centers for Medicare & Medicaid Services (CMS) sometimes develop policies to limit Medicare coverage of specific items and services. MACs issue local coverage determinations (LCDs) that limit coverage for a particular item or service in their jurisdictions only. So, the requirements in one state or region may be different from another state or region. In general, Medicare requires that sleep studies are performed in the correct setting (in home or in a sleep center), using the right equipment (there are requirements for the number of channels to be recorded) and for the correct amount of time.
Medicare has specific groups of codes to be billed for each service. Many other insurance companies follow Medicare’s guidelines and coding. Medicare will cover sleep studies performed in a hospital-based, physician-run or IDTF sleep center as long as other requirements are met.
Here’s a link to the LCD for polysomnography and sleep studies in California.
To learn more about different types of sleep studies, the sleep disorders they can diagnose and the appropriate billing codes, download our guide.
Download Study Types & Codes Guide
Sources:
http://www.sleepreviewmag.com/2011/04/structured-to-thrive/
https://med.noridianmedicare.com/documents/10542/2840524/Polysomnograpy+and+Sleep+Studies+Presentation
http://respiratory-care-sleep-medicine.advanceweb.com/Features/Articles/The-In-and-Outs-of-Sleep-Center-Accreditation.aspx
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