Knowledge is Power

Hold on to those Reimbursements

600x300_nierman_billingIt’s wonderful that so many dentists are successfully billing medical insurance to help their patients with access to care for oral appliances. When billing in this arena, it’s important to possess knowledge of medical policies which provide your practice with the “power tools” to more easily receive reimbursements and also to retain those reimbursements. Since misinformation about medical billing and coding that can be  detrimental to a dental practice is commonly presented, knowledge of current medical policies for Dental Sleep Medicine and TMD appliances is essential. Misunderstood terms can also come into play. As an example; during our recent Medical-Billing-for-Dentists seminar in Atlanta, a participant stated, “we don’t have to worry about following documentation guidelines or requests for refunds because we bill out-of-network.” This statement is far from the truth. The act of billing or providing a patient with codes opens the door for insurers to verify that the billing is correct. Even when using a third party biller, it’s essential to have knowledge of the correct codes, ethical billing protocols, necessary documentation and what’s being billed. The dental practice is, ultimately, responsible for the codes billed and for generating the necessary narrative reports and documentation.
Thus, training and education in medical billing for dentists is as important as clinical training for oral appliance therapy. We have seen a few audits in Dental Sleep Medicine (DSM) and Temporomandibular Dysfunction (TMD) and expect reviews to increase as progressively more patients are undergoing these life-changing treatments.
A Few Questions to Consider
Are you up-to-date on documentation requirements that support evaluation and management codes that you bill? Did you know that the American Medical Association, in conjunction with The Center for Medicare and Medicaid Services (CMS) created Guidelines for Billing Evaluation and Management Codes? This guide shows how to document the extent of your verbal “Review of Systems,” specific “Examination Elements” and the level of medical decision-making.
Are you aware of recent changes in some commercial insurance policies specifying that using a “Medicare-cleared” (PDAC approved) OSA appliance is now a requisite for reimbursement? Do you question whether you can bill on the date of the impression or upon delivery?
Are you up-to-date with insurance carrier policies, regarding the need of an MD prescription, Proof of Delivery form and other documentation for an OSA appliance?
Can you bill for a morning re-positioner as an accessory to the sleep appliance or is this “nickel and diming” commonly referred to as “unbundling”?
Are you sending narrative reports to the patient’s other physicians – and how important is this to communications when treating a medical condition such as OSA?
These are important questions to be answered and underscores the importance of education in medical billing for dentists and risk management when providing DSM and TMD services.
Pursue the knowledge and “power tools” to stay current with documentation requirements for TMD and OSA. To ensure the maximum reimbursement and compliance, consult an expert or attend an educational program designed to provide the answers to these burning questions. Empower your practice with the knowledge to be successful!

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