Article Detail - JF Part A

On November 2, 2022, the American Academy of Sleep Medicine (AASM) released an article on their website discussing an increase in claim denials related to follow-up diagnostic sleep studies. Noridian has contacted the AASM to request clarification to the published article regarding the Targeted Probe and Educate (TPE) sleep study claim reviews.

Noridian has verified that there were no identified claims denied during a TPE review due to an LCD misinterpretation; therefore, there will not be any re-review of previously denied claims. If you have additional documentation for claims in an open TPE file, you may work with your Noridian nurse clinician using the medical review reopening request process. If you have additional documentation or disagree with Noridian’s determination for a closed file, your facility should follow the redetermination process.

Additionally, monitoring will remain in place and any new TPE reviews or other actions may be initiated as appropriate through the improper payment reduction strategy efforts.