Who we serve · Sleep medicine and pulmonology

Sleep medicine and pulmonology practices. Each study, device and biologic documented the way the payer reads it.

For independent sleep medicine and pulmonology practices, HRI Med offers billing, enrollment and denials, followed claim by claim the way HRI follows them for behavioral-health facilities. We enroll the practice, its sleep lab and every clinician with each payer, request study and drug authorizations before the appointment, and bill each study in the right parts.

Request a review Where payers push back

iWhere payers push back

Lab approvals, split studies and device rules.

UnitedHealthcare's commercial plans require prior authorization for sleep studies done in a lab, and leave home studies off that list.^A Every other plan keeps its own list.

Novitas, one of the Medicare contractors, expects a sleep lab outside a hospital to hold AASM, Joint Commission or ACHC accreditation, under a physician board-certified or board-eligible in sleep medicine.^B A lab that stands apart from any physician's office enrolls as an independent diagnostic testing facility, under federal standards of its own.^C

A lab study has two parts, the recording and the reading. When a hospital runs the recording, the practice bills the reading alone, coded to where the patient slept, even if the physician read it from the office.^D

Medicare covers a PAP machine after an in-person evaluation and a qualifying sleep test. To keep paying after the trial, it wants an in-person re-evaluation and the machine's own data showing use of four hours or more a night on 70% of nights.^E No part of a home sleep test, not even dropping off the device, may be done by a DME supplier.^F

Home oxygen qualifies on a blood gas or oximetry result, such as saturation at or below 88 percent at rest on room air, taken in person. Unsupervised home testing does not count, apart from overnight oximetry run under an independent testing facility.^G UnitedHealthcare's commercial policy for Nucala, given in the office, asks for severe eosinophilic asthma that stays uncontrolled on maximal inhaled therapy, a pulmonologist or allergist as the prescriber, and a renewal once the first approval runs out.^H

iiWhat we run

The lab, the clinic and the claims, in one file.

Enrollment: The practice, each lab location and every physician, NP and PA, with Medicare, Medicaid and each commercial plan on your list. Each followed to an effective date.
Authorizations: Lab studies and office-given biologics requested before the appointment, and renewals tracked before they lapse.
Claims: Each study billed whole, as the reading alone or as the recording alone, by where it ran. Device and oxygen paperwork checked before the order leaves.
Denials: Sorted by cause, then appealed wherever the practice is owed.
The Friday board: Where each application stands, lab by lab, and once billing runs, which study and drug claims paid and which did not.

Fees for a sleep or pulmonology practice. The full card is on the pricing page.
Piece of work	Fee
The practice's own application, per payer	$350
Each sleep physician, pulmonologist, NP or PA, per payer	$250
Building or repairing one clinician's CAQH ProView profile (CAQH now operates as DataSpring)	$150
Billing and revenue cycle	By agreement

Total your own enrollment with the calculator.

iiiQuestions

Common questions from sleep and pulmonology practices.

Do home sleep tests need prior authorization?

Under UnitedHealthcare's commercial list, no, only lab studies. Other plans set their own rules, and we keep each one on file.

Why did Medicare stop paying for a patient's CPAP?

Continued coverage needs an in-person re-evaluation and the usage data. When either is missing, Medicare stops paying, so we check for both before the trial ends.

A new pulmonologist is joining. What has to be filed?

Each payer takes one practitioner application for the pulmonologist at $250, and a CAQH profile that needs building adds $150. For Medicare, we also link the new physician to your group.

Sources

UnitedHealthcare, commercial prior authorization requirements, sleep studies. Read 2026.
Novitas, LCD L35050, Outpatient Sleep Studies. Read 2026.
42 CFR 410.33, independent diagnostic testing facilities. Read 2026.
CMS, Medicare Claims Processing Manual, chapter 13, section 150. Read 2026.
DME MAC LCD L33718, Positive Airway Pressure Devices. Read 2026.
DME MAC policy article A52467, Positive Airway Pressure Devices. Read 2026.
DME MAC LCD L33797, Oxygen and Oxygen Equipment. Read 2026.
UnitedHealthcare, Respiratory Interleukins commercial medical benefit drug policy. Read 2026.

Send us the sleep and pulmonary claims that stall.

Name the tests, the drugs and the payers. We tell you what each claim is missing, and we need no patient information to do it.

Say whether sleep studies run in a lab, at home or both.

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