WPS GHA has received many inquiries regarding the credentialing of sleep labs under this LCD. The intent of the LCD and the coverage guidance is to ensure that Medicare beneficiaries are being diagnosed and treated by providers and in facilities that meet the specialty standards to ensure the highest accuracy and quality. Accreditation ensures safety and adherence to standards required for facility operations while credentialing addresses training and specialty board academic standards.
This notification will clarify the credentialing of sleep labs in Jurisdictions 5 & 8.
Sleep disorder clinics are facilities in which certain conditions are diagnosed through the study of sleep. Such clinics are for diagnosis, therapy, and research. Sleep disorder clinics may provide some diagnostic or therapeutic services which are covered under Medicare. These clinics may be affiliated either with a hospital or a freestanding facility. Whether a clinic is hospital-affiliated or freestanding, coverage for diagnostic services under some circumstances is covered under provisions of the law different from those for coverage of therapeutic services. (CMS publication 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 70)
The LCD states the credentialing criteria:
- The sleep facility credentials must be from the American Academy of Sleep Medicine (AASM), inpatient or outpatient;
- The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)) sleep specific credentials for Ambulatory care sleep centers.
- Accreditation Commission for Health Care (ACHC)
The certification requirements for AASM and ACHC remain unchanged as stated in the LCD L36839, Polysomnography and Other Sleep Studies.
WPS GHA understands that some sleep labs may have the general The Joint Commission (TJC) credentialing for their hospital and not the sleep specific credentialing that is required.
To allow these labs to become compliant with the current LCD, and with minimal provider burden, the following process will be implemented:
- All sleep labs which 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 this notification.
- 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 this notification.