MHA Monday Report April 10, 2017

Posted on April 10, 2017

MHA Requests Enforcement Delay for WPS Local Coverage Determination

Effective Feb. 16, 2017, Wisconsin Physician Services (WPS), the Medicare Administrative Contractor for most Michigan hospitals, implemented new coverage criteria through a revised local coverage determination (LCD-L36839) that affects accreditation for polysomnography and other sleep studies and Medicare fee-for-service reimbursement for those services.

Prior to Feb. 16, the previous local coverage determination (LCD-34353) required that a sleep lab be accredited by one of three agencies:

  1. The Joint Commission
  2. American Academy of Sleep Medicine (AASM) – inpatient or outpatient
  3. Accreditation Commission for Health Care (ACHC)

Based on the earlier LCD-34353, hospitals often relied on their accreditation by The Joint Commission to cover sleep lab services. The recent LCD-L36839 specifies that sleep labs require sleep-specific credentials from The Joint Commission for ambulatory care sleep centers, which is a key change and an increased cost from the past. Consistent with the past, the AASM and the ACHC continue to accredit facilities for these services.

In a letter sent to WPS last week, the MHA requested that WPS delay the enforcement of the recent LCD-L36839 until Jan. 1, 2018, to allow hospitals time to obtain the accreditation, which could take more than six months. The MHA encourages hospitals to contact The Joint Commission and request the certification for their sleep labs, since The Joint Commission does not require hospitals to wait for their next certification cycle. In addition, the association urges hospitals to email Cheryl Ray, DO, medical director at WPS, and provide examples of the negative impact this change has on patients in their communities. Members with questions should contact Vickie Kunz at the MHA.


  • MHA Monday Report April 10, 2017

Tags: Pyxis, Medicare, MAPS, Medicaid, pharmacy, Healthy Michigan Plan, Health PAC, Healthcare Leadership Award, Appriss, goal, Human Resources Conferance, WPS local coverage determination, sleep labs, Joint Commission, laboratory fee schedule, RCA2, MBI, HICN, Board meeting

Posted in: Monday Report

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