Obstructive sleep apnea (OSA), a kind of sleep-disordered breathing (SDB), is a severe medical illness that is characterized by recurrent total or partial collapses of the upper airways (Aibek E Mirrakhimov, Talant Sooronbaev & Erkin M Mirrakhimov, 2013). Approximately one billion adults between the ages of 30 and 69 are thought to suffer from obstructive sleep apnea (OSA), with the majority of cases going misdiagnosed and uncontrolled (Adam V Benjafield, Najib T Ayas et al., 2019). There is a greater possibility that the occurrence of OSA would rise over time due to increasing obesity, chronic illness, and population aging rates (Dr Amy S Jordan, David G McSharry, Prof Atul Malhotra, 2013).
Dentists are required to offer treatment to patients. The preferred therapy is continuous positive airway pressure, with a 60–70% compliance rate (Dr Amy S Jordan, David G McSharry, Prof Atul Malhotra, 2013).3 For non-compliant CPAP patients, oral devices are the second-line treatment. According to a report, oral appliance therapy—the most popular alternative to CPAP—is preferred by 81% of patients (Jennifer Q. Le, Jeff L. Rodgers, Kevin Postol, 2018). The therapeutic appliances for sleep apnea by a dentist are not covered by dental insurance. They are considered in medical billing and covered by medical insurance. It is challenging for a dentist to perform medical billing for sleep apnea treatment. For this, we have elaborated simple tips for sleep apnea medical billing for dentists
What dental oral devices that treat apnea are covered by insurance?
Dental insurance does not cover sleep apnea as it is a medical issue. This suggests that we seek coverage through medical insurance. Many medical insurers will pay for dental or oral appliances used to treat apnea, particularly if the patient’s insurer would have paid for CPAP therapy. Based on the insurer, the coverage might be anywhere between 50% and 100%. Insurance may not cover oral appliance therapy, but this is uncommon. If you talk about Medicare, it will cover payments if you meet specific criteria. Medicare covers your CPAP device. A routine replacement schedule for tools like masks, filters, caps, etc., will also be included. The term “durable medical equipment (DME)” denotes that your CPAP machine will be covered by Medicare Part B. The requirement list presented by Medicare to pay money for oral appliance medical billing is as follows:
- According to recommendations made by the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine, those who have OSA symptoms need to visit a sleep medicine doctor in person for a diagnostic purpose and to receive dental appliances (Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD., 2015).
- The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommended that sleep doctors perform follow-up sleep testing to improve or validate the treatment’s effectiveness. (Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD., 2015)
- You have to go through a coding verification review by the PDAC contractor.
Profitable tips to simplify dental billing for obstructive sleep apnea
Use practice management software to simplify dental insurance
For your SOAP notes and communications with physicians and payers, you need to employ a portion-specific software platform. These systems ensure that the proper notes, tests, patient condition, and history are included so you can be compensated. Medical reimbursement and DSM are governed by strict documentation of procedures, guidelines, and best practices. Selecting the best Diagnostic practice management software is the first step in billing since it will prevent you from forgetting to gather essential data. A form of medical software known as a medical practice management system (PMS) deals with the daily activities of medical practice at a doctor’s office and is used to control daily tasks at a hospital, nursing home, or physicians’ clinic (Sanjeev Davey and Anuradha Davey, 2015).
The key is understanding documentation
Specific documentation is necessary for successful medical billing and payment from medical insurance. The source of funding that may have the most significant impact on data quality is the documentation that clinicians finalize to explain a patient’s interaction with a healthcare facility (Kelsey Lucyk, Karen Tang & Hude Quan , 2017).
- While treating and billing for sleep apnea, you must have a diagnosis of sleep apnea by a board-certified specialist in written form.
- Copy of sleep test that is performed in lab is also required sometimes.
- Before addressing this condition and while making a bill, you must have a written order of using appliances by a physician to reimburse.
- SOAP notes are mandatory. In addition to serving as a communication tool between medical personnel, SOAP notes are an essential source of information regarding the patient’s health condition (Podder V, Lew V, Ghassemzadeh S., 2022).10 In SOAP notes, diagnostic information, symptoms, and treatments are listed.
Understand medical policy guidelines
Regarding sleep apnea therapy, the insurance must adhere to specific medical policy criteria that outline what it will cover. You must thoroughly know the policy’s requirements to guarantee compliance, such as which therapies will be covered using an oral appliance.
There are two kinds of sleep tests: a polysomnogram (PSG) and a home sleep test (HST). A copy of the sleep study supporting the diagnosis of OSA is required as supporting documentation for the medical need for some oral appliance therapy. The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommended that sleep doctors perform follow-up sleep testing to improve or validate the treatment’s effectiveness (Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD., 2015). There are restrictions placed by certain insurance companies on the kinds of tests they will pay for. As an illustration, Medicare now demands that home sleep testing be utilized before PSG may be covered. Moreover, a particular AHI is advised by some payers for patients to be reimbursed for therapy. The patient’s AHI must thus be specified in detail in your sleep test reports.
Understand medical policy guidelines
It is said that Medicare pays money only to providers with the contract. You may have a contract with Medicare under the category of medical services, which is divided into two categories: physicians and medical providers. Medicare will pay only providers with contracts. You will then have a DME contract that authorizes you to offer medical supplies, including CPAP machines and oral appliances.
Apnea is a medical problem, not a dental one; hence dental insurance must not be employed to pay for dental equipment. Utilizing dental benefits for a medical issue would put the patient at a loss.
Outsource the Details to a Competent Billing Company
Medical coding is quite complicated for dentists who address sleep apnea. In the United States, medical mistakes are still a significant issue (Amirmasoud Momenipur and Priyadarshini R. Pennathur, 2019). Simple blunders might have considerable consequences for your dental office and patients. By outsourcing your sleep apnea medical billing, you can be confident that the claims are made accurately and that the patient’s health insurance is used to its greatest potential. Outsourcing has been viewed as a way of reducing issues in most public enterprises (Saeed Karimi, Zahra Agharahimi, and Maryam Yaghoubi, 2012). A group of professionals controlling the billing will avoid overlooking possible cost-saving options while guaranteeing the proper payment for the service.
Hire MedsDental billing company for medical billing of sleep appliances
Outsourcing the billing section to a trustworthy billing company is no longer uncommon. In providing accurate billing for your dental practice, MedsDental Dental Billing Company is around the corner to outsource your practice with this company. Our professionals know the steps involved in medical billing for dental appliances for sleep apnea. We file accurate claims with the correct coding and attachments to get reimbursed quickly. Our company has implemented modern and reliable technology to perform each step speedily and flawlessly, so there will be no delays in any billing phase. Moreover, we provide HIPAA-compliant billing services to protect your patient’s data without any onboarding cost. We believe in providing quality services to our partners to improve their revenue. So, why stress about billing when MedsDental is ready to take this responsibility?