Article - Accreditation and Credentialing Requirements for Polysomnography LCD L36593 (A55958)

CMS National Coverage PolicyN/AArticle TextRevision effective date:For services performed on or after07/01/2018Accreditation and credentialing requirements:Please be aware of the following changes to accreditation and credentialing requirements:The related Polysomnography LCD sets forth the following standards for sleep centers that perform the technical component (TC) of polysomnography (PSG) and sleep testing (including home sleep testing):1.The sleep center or laboratory must maintain documentation on file that indicates it is accredited by either:the American Academy of Sleep Medicine (AASM), ortheAccreditation Commission for Health Care (ACHC), orthe Ambulatory Care Accreditation Program of the Joint CommissionThis documentation must be available on request. The AASM, ACHC, or Joint Commission accreditation applies to the hospital and freestanding facilities (including sleep clinics that are part of a physicians office, and all other non-hospital-based facilities where sleep studies are performed.Diagnostic testing performed in an Independent Diagnostic Testing Facility (IDTF) must follow the supervision and credentialing guidelines set forth by CMS and/or this A/B MAC.The sleep laboratory or testing facility must be affiliated with a hospital or be under the direction and control of a physician (MD/DO) who meets 1 of the following requirements, even though the diagnostic test may be performed in the absence of direct physician supervision.The raw data from all sleep tests must be reviewed and the tests must be interpreted by a physician who meets at least 1 of the following requirements:Certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM) or by a member board of either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)A completed fellowship in sleep medicine through an Accreditation Council for Graduate Medical Education (ACGME)accredited program. Following the completed fellowship, certification in sleep medicine is completed within 2 examination cycles through the ABSM or a member board of either the ABMS or the AOASleep centers in Jurisdiction M have been subject to these regulations since the implementation of the LCD on October 1, 2015 and similar regulations that appeared in previous versions of the Polysomnography LCD.Sleep centers in Jurisdiction J prior to February 26, 2018 were not required to meet similar standards by the previous contractor. All sleep centers in Jurisdiction J must now obtain accreditation by 1 of the 3 organizations listed above by July 1, 2018 in order to continue to render services to Medicare beneficiaries and submit claims to this A/B MAC.Revision effective date:For services performed on or after10/01/20182. As noted above in section 1, and as of October 1, 2018, outpatient sleep centers affiliated with a hospital, which is currently accredited by the Joint Commission (formerly JCAHO) through the hospitals accreditation are required to have ambulatory care accreditation for the sleep center in order to continue to render services to Medicare beneficiaries and submit claims to this A/B MAC.3. There is a new physician-credentialing standard published by the Joint Commission (formerly JCAHO) for ambulatory care organizations providing sleep center services that reduces quality variation and aligns credentialing requirements for all sleep testing facilities defined by the Polysomnography LCD. Specifically, as of January 1, 2018, the Joint Commission requires that organizations verify that physicians haveat least 1of the following qualifications before granting initial or revised privileges to physicians responsible for interpreting sleep studies:Certification in Sleep Medicine by the ABSM or by a member board of either the ABMS or the AOAORA completed fellowship in sleep medicine through an ACGMEaccredited program. Following thecompleted fellowship, certification in sleep medicine is completed within 2 examination cycles through the ABSM or a member board of either the ABMS or the AOA.The above language is not a new requirement under the related Polysomnography LCD. Since its implementation on October 1, 2015, the related LCD has required and continues to require, regardless of the standards put forth by any of the 3 listed accrediting organizations, that the sleep laboratory or testing facility be affiliated with a hospital or be under the direction and control of a physician (MD/DO) who meets 1 of the above requirements. The raw data from all sleep tests must be reviewed and the tests must be interpreted by a physician who meets at least 1 of the above requirements. This documentation must be available upon request. Please review the related LCD for complete information regarding polysomnography testing and billing requirements.