This column features experts on medical billing answering question on best practices, practical advice, and procedures that sabotage success.
Providing life-saving care for patients is the #1 reason dentists get involved in Dental Sleep Medicine (DSM). Issues related to medical billing seem to be the #1 obstacle dentists cite for abandoning DSM. You provide the best treatment money can buy, so you expect to be compensated appropriately. This is where the frustration, disappointment, and confusion can set in.
In each issue of Dental Sleep Practice, we ask numerous experts three questions. No one, not even the most prolific DSM practices, sees more cases than the top DSM billing companies. In hopes of helping you avoid or overcome medical billing pitfalls, we asked CEOs from the most highly regarded DSM billing companies the following questions about best practices and ways to avoid self-sabotage. These are the responses “In Your Own Words.”
- What is one way practices consistently sabotage their medical billing success?
- What is one best practice your most successful clients have in common?
- What’s one piece of PRACTICAL advice you want to impart on readers that they can use tomorrow?
Pristine Medical Billing
- While all practices go into this venture with the best intentions, many practices fail to follow the proper workflow. The insurance carriers have given us the playbook with policies, but at times the dental practice will try to call an audible on the play and deliver an appliance before a pre-authorization or gap has been approved. It’s imperative to listen to the advice of a third-party expert when setting up the workflow and documentation protocols to ensure reimbursement. Don’t be a lone wolf.
- A strong dedicated team member that is willing to learn new things, has an open mind, is patient with the process/protocols, and is given the time and support to implement a new program. Every bada$$ DSM practice has a bada$$ quarterback leading the charge. The practice that truly understands that dental sleep medicine will take some time and payroll to develop the program, will always have the advantage over the practice who desires immediate results with minimal effort.
- Be patient with the process. Understand that building a dental sleep medicine program is a marathon not a sprint. Start simply with your own patients and set a goal of two appliances per month for the first six months. Small victories are still victories. Then double that goal every six months. Within two years the goal is 16 per month and that would put you at the level of the elite DSM practices across the country. While doing this, the practice will methodically develop the best strategies for their unique business. Also, understand that medical insurance is just part of the payment and not the magic The practice still needs to do a good job of articulating the medical urgency to convert the treatment.
- Missing medical documentation is the most common weapon of destruction in sabotaging a claim payment. The doctor and team can do everything exactly right in regard to patient care, but if they don’t have the very specific paperwork the insurance requires – *POOF* – no claim payment.
- The medical files should read like a story. We can tell who is working with their MDs because the full story can be told. The story begins with when the apnea was suspected, screening was performed, patient was tested, and treatment was ordered. Some get a little more complicated than that, but it makes for interesting reading. Dental offices who do a great job communicating with their referring offices and send patients back and forth are always the most successful. The offices that try to patchwork a case or do everything themselves, they end up quitting.
- Trying to track down an old sleep study? STOP! Refer them out for a new consult visit and test. If the study is less than a year or two old, and the patient is not eager about a new one, try calling the sleep lab directly. Have all your patients sign a records release consent form and bypass the PCPs or specialists if needed.
Nierman Practice Management
- This can be summed up with two words – insufficient documentation! Medical insurers require a higher level of detail of clinical notes than dental insurers, so it is imperative that dental practices become proficient in documenting in SOAP format (subjective, objective, assessment, plan) to ensure successful reimburse Knowing the correct codes is surely important, but it’s the documentation that will make or break your case! Utilizing a system to organize and drive this is key.
- This one can be summed up into one word – communication! Ample communication with the medical community is by far the most common trait we observe in successful practices. A stable communication protocol consisting of written communications to the patient’s referring doctor and other providers they see, plays a critical role in both securing referrals and reimbursement. Physicians want to know the patient’s oral appliance progress and medical insurers may require documentation from the treating physician to approve reimbursement.
- Get educated on DSM and medical billing for dentists. I cannot stress enough the importance of educating all involved parties in the dental office. The patient perceives the dental practice’s level of knowledge and comfort in DSM starting with the first phone call. The administrative, clinical, and medical billing team (whether in-house or 3rd party) all have a significant impact on the patient’s decision to accept treatment. Hence, our motto: Get your ducks in a row!
- Medical billing is so different than dental billing. Generally, practices are expecting the same processes and guidelines with medical billing. Trust your biller! Erase all the things you know about dental billing and find a reputable biller to help lead the way. Then replicate that over and over for your patients! Your billers want to get you paid!
- Well trained teams! A doctor who is successful educates every part of their team and allows them to work as a unit from the very beginning. The best thing you can do is hire someone to be dedicated to sleep instead of letting it be an “add on” to an existing employee’s duties. I think you’ll find a dedicated employee (or team in a lot of cases) will work a whole lot harder to make it succeed!
- Communicate, communicate, communicate! Ask your billers what they expect of you, and let them know what you expect of them! When a biller can manage your expectations from the beginning, you’ll find your processes will run more smoothly and you’ll know what to expect regarding billing. They can help you to understand what can reasonably be controlled and what we leave to chance with insurance.
4 Pillar Billing
- Practices mistakenly assume that medical and dental billing are similar. Offices may have effective protocols for dental billing and attempt to utilize the same systems, protocols, and philosophy in medical To make matters worse, these offices often fail to seek help from experienced medical billing companies. It is a recipe for failure. My advice is to initially set a reasonable cash fee to begin gaining experience in DSM while developing your billing protocols.
- In short, well defined workflow and responsibilities. Most successful DSM practices are driven by leaders who share a clear vision of their goals while establishing well defined DSM systems and team member roles to achieve that end. Successful practices have an in-depth understanding of each step of DSM implementation, have a well-defined process for accomplishing those procedures and have clearly designated responsibilities for those actions.
- Don’t overthink or delay treating your patients. We have witnessed far too many offices who feel they just need one more course, a little more time, or who use one of hundreds of other excuses to prevent them from getting started. Meanwhile their patients and practices are suffering. This isn’t that complicated. You will learn to do this just like you learned how to do dentistry – by doing! Get started now!