The AASM has researched and consolidated data from nearly 700 private insurance companies and Medicare local coverage determinations throughout the country. Results from the research shows that assorted insurance companies are beginning to require that sleep studies must be performed in an AASM accredited centers as an indication for reimbursement.
A review of local coverage determinations for Medicare policies has shown 10 states that require AASM accreditation. The 10 states are served by five different carriers and the language for each policy can be read in an attached document titled “Medicare Coverage." Many of the states reside in Medicare Region VI and include Louisiana, Oklahoma and New Mexico as states that require AASM accreditation.
Of the 658 private insurance companies researched the data provided information on 17 states that require AASM accreditation as a prerequisite for reimbursement. The language for each policy can be read in links listed below. The largest carrier to require specific accreditation policies continues to be the various BlueCross BlueShield organizations throughout the country. Several smaller insurance companies also require AASM accreditation but the total number of individuals that the various small insurance companies cover is unknown.
The AASM will continue to monitor sleep medicine policies originating from Medicare carriers and local insurance companies. The AASM is committed to work with Medicare carriers and local private insurance companies in an effort to make AASM accreditation a mandatory requirement in national and local insurance coverage policies and areas.
For more information, or if you wish to report policies in your area that require AASM accreditation, please contact the AASM at (708) 492-0930 or at GovernmentRelations@aasmnet.org
AASM Accreditation in Medicare Coverage Determinations
AASM Accreditation in Local Insurance Medical Policies