On May 10th and May 12th, respectively, CGS Administrators, LLC (“CGS”) and Wisconsin Physician Services, Inc. (“WPS”) issued clarifications related to the MACs’ Local Coverage Determinations (“LCDs”) for polysomnography and other sleep studies. Click here for background on these LCDs.
Due to efforts by state hospital associations, the MACs recognized that some hospitals relied on their general hospital accreditations in order to provide covered sleep testing services. In order to give hospitals time to come into compliance with the current LCDs that require sleep-specific credentialing, the MACs have established the following processes.
- All sleep labs that had the TJC general accreditation prior to February 16, 2017 must request and apply to the TJC for the ambulatory care sleep specific credentials. This must be done within 90 days of the publication of the notification (May 12, 2017).
- The application and letter from the TJC must be available upon request by WPS GHA.
- The final credentialing must be in place within 12 months of the publication of the notification.
Click here to view the WPS guidance.
- All sleep labs must apply for credentialing by one of the organizations listed in the LCD (AASM, ACHC or TJC sleep specific credentials for ambulatory care sleep centers) within 90 days of the publication of the CGS article (May 10, 2017). The application and a letter from the credentialing organization that verifies that an application is in process must be available upon request by CGS.
- All sleep labs must have final credentialing by one of the organizations listed above as stated in the LCD in place within 12 months of the publication of the article.
- A sleep lab may request an extension if needed. The need for an extension should be very rare and will be granted for extenuating circumstances only.
Click here to view the CGS guidance.
Note that the WPS guidance is more restrictive than the CGS guidance since it limits the temporary process to only the TJC ambulatory care sleep specific credentials for the hospitals that relied on their TJC general accreditation prior to February 16, 2017. CGS is permitting hospitals to apply for any one of the three available sleep credentials for purposes of compliance.
If you have any questions regarding this coverage update, please contact Regan E. Tankersley at (317) 977-1445 or firstname.lastname@example.org or your regular Hall Render attorney.