Filing Insurance For Oral Appliance Therapy P5

So, if you use these basic simple codes right here, and you have the case fee, whether it’s $2500, $3000, $3500.  Whatever the fee is, if you have your diagnostic information and all the codes associated with your medical billing, you use straight codes here, and you collect up front. Tell the patient you don’t know what the reimbursement is, but, based on the information that you have gathered, they have a percentage back.  Bingo, you’ve collected your total fee.  You submit it.  The checks come back.  They’ll come to you or the patient depending on how it’s in-network or out-of-network.  When they come to you, hand them a reimbursement and be done with it.

Every Thursday afternoon, I usually write anywhere from one to five, six, seven reimbursement checks from the medical side of it, and I’d much rather do that than go through the hassle of continually building each one of the codes.

What’s next?  Filing the paperwork. You’ve got everything from EOBs to electronic filing to status checks for claims to denials and appeals to peer reviews.  I mean it’s exhausting.  Here’s that CMS 1500 if you’re not familiar with.  My software spits that out.

I’m going to run through these really quickly as far as the 1500 because I see we’re getting a little tied up on time, but filling out the form, make sure that you always have the diagnosis codes listed in order of importance. For example, it’s OSA.  Diagnosis of the OSA, that’s going to always provide medical necessity.  Always make sure that you list your CPT codes ranging from the most expensive all the way down.  Make sure you complete all the fields on the forms and make sure you stay inside the lines because they’ll look for any reason to kick you out.

The first 13 boxes is basically patient information; 14 and 15 is when the symptoms occur.  Box 17 is your referring physician, and guess what?  Boxes are going to have sub-boxes so they’re going to want stuff like NPI numbers for your physicians.  For additional notes, CPAP intolerance.  By the way, with the sheet that you get those forms, the directions, you can go online, and they’ll tell you what these boxes are for and what to fill in each one of them.

Box 22 is for Medicaid only.  Box 23 is your pre-authorization number and so forth, dates of service, places of services.  You usually won’t need that one.  You’ll list your CPT codes, your diagnostic codes, charges for each code, list of the units, your NPI number, your TIN number, optional.  If you want to accept your insurance assignment, you say “yes” or “no” there.  Charges for record.  Again, these codes just go on and on and on.  They go in all these boxes.  The total for the claim, that’s really important for you guys to know, and your signature. Then, the last part of it is going to be the location in which your services took place and the name and so forth.

Now, you want answers to all those questions?  Here’s where you get your pen.  Get your sharpener out and get it going.  Here we go. I have a software. I got online with a software company called Nierman Practice Management.  Some of you guys may already have this.  Their update is phenomenal.  It is literally the most customizable software out there.

What’s great about Nierman Practice Management, and that’s the number, 1-800-879-6468.  Rose Nierman owns the company.  She’s phenomenal.  Glenina is great.  The software program is about $4500, and the in-office training is about $1500.  That $1500, to me, outweighs the $4500 that you pay for the software.  Glenina comes in, and she customizes it for you.  She’ll show you a lot of tricks to the trade with regards to filling out the information.

What I love about the Dental Writer is it has a diagnostic and questionnaire reporting exam. Basically what you do is in each one of my computer rooms, I have a flat screen, touch screen computer on the wall, and we pull up the Dental Writer.  Basically, what it is that there’s tabs that you go through.  You click on the tabs, and my assistant reads the part of the exam that I do. I do it with the patient, whether it’s the Epworth or the Mallampati or the tonsils score or this or that, and she just clicks and touches the button and fills in all of it.  When that tab’s completed, she goes to the next tab, and she reads off all the things that I need to do.

Once we go through all the tabs, this software will then go to a diagnostic report.  It automatically writes your SOAP note. It automatically writes your medical necessity, the one that I showed a minute ago.  It automatically writes everything for you. It will also send a “thank you” letter to the referral doctor.  It does everything for you.  It is absolutely the most phenomenal thing I have ever seen.

If there’s components that you don’t one, they can go and delete those for you so you never have to see them again.  If there’s stuff you’re looking for that’s not there, it’s easily customizable.  They’ll show you how to do it yourself, or they’ll do it for you.  It is a great, great way to do it.  It will print out that CMS 1500 form with all those boxes already filled in.  You don’t have to worry about it, and it just fills it in the line so the insurance companies can’t keep track and say, “Sorry, we’re not going to pay for it.” Then, there’s cross coding for medical as well.

I really highly recommended.  I use it.  It’s great.  It’s been a really great work force.  It also keeps track outside of our [46:06], which patients are using OSA and so forth.  Then, the other one is this company out here.  There’s several of them out there.  This is obviously a Texas-based company in San Antonio.  Basically, they don’t get paid unless you get paid.  What they do is they take over the information, and they submit all the claims, make sure everything’s done correctly before they submit it.  Once the reimbursement comes back, you pay them.  For example, if you submit $3000 and you get $2500 back, you owe them $250, but you don’t have to go through all the stuff we went through in order to do some courtesy bill.

Again, dental sleep medicine and craniofacial dentistry has been great for me this past year.  I’ve been happier in dentistry than I ever had in my entire life.  I’ve done more full-mouth rehabilitation cases this year than I ever had in practice in 18 years, looking at people’s airways, opening them up, and getting them back to where they need to be at a better place in life, and I just say enough great things about it.

If you guys have any questions or any comments, we’re going to take a couple of questions, comments, if I’m not mistaken. I’ll be glad to answer them, and here’s my information.  Feel free to call me. I always return phone calls, and I always return e-mails.  They may not be right at that second, but they will usually get done by the end of the day.

Again, thanks Arrowhead for letting me participate in a webinar, and thank you guys for listening to me.  I hope I didn’t carry on too long or talk too fast.  Matt, do we have any questions?



Thank you very much, Dr. Cress.  I’ll give you a quick second to catch your breath.  I just want to remind all the attendees that we did go over a lot of information.  This PowerPoint will be available if you want it.  The only thing that we ask and the reason that we ask is we don’t want to be accused of spamming our attendees, but if you’d like that, make sure you fill out the question on the survey where it asks if you’d like it e-mailed to you.  We’ll go ahead and take care of that for you.

With that, we’ll go ahead to some of the questions.  We got a number of questions from your presentation, Dr. Cress, and I’ll just try to go into those now.  The first one is from a doctor.  He asks, “In your opinion, do you feel that OSA is going to become a viable means for a dentist to access the more lucrative medical insurance?”


Dr. Cress:

Oh my gosh.  You have no clue.  I don’t know who the dentist is, but give them my number.  I’ll give them the financial numbers directly.  It has been phenomenal, and I will tell you.  It’s really a great adjunct to help your patients.  Yeah, I mean, we can do bleaching and we can do all kinds of interesting cosmetic things and so forth, but when you start talking about their overall health and putting them in a better overall position in life, from a mood perspective, it’s just incredible.

So, to answer your question, absolutely yes.  It’s alarming to see the number of memberships who have grown in the American Academy of Dental Sleep Medicine and the American Academy of Craniofacial Pain.  It’s just been leaps and bounds.  The answer to the question is absolutely, 100%.



Great.  The next question is, this is a doctor asking, “What things do I need to have in place to start offering sleep dentistry, in your opinion?”


Dr. Cress:

Well, again, where I actually generated after the TDA meeting in San Antonio, was I came back that Monday, and I printed out the Epworth.  I got it off the internet. I printed up the Epworth.  I put it in my format, and I started asking every single question.  Those individuals that come back that have 8 or greater, I then started looking from a diagnostic standpoint with regards tyou o their work facades or sore eye, their scalped tongues [49:30] and so forth, keeping in mind that that particular lecture is given at Arrowhead for the sleep component of it.  I encourage everyone to sign up for those and learn how to do that.

Then, you start looking beyond Ts and you start seeing things that are very suggestive of OSA. The next step is obviously a sleep study and/or a home sleep study in order to confirm your initial diagnosis.



Okay.  The next question kind of regards your mentioning sleep doctors or sleep MDs.  The question is, “With OSA and sleep dentistry, what is the type of interaction I’m going to be having with MDs?”


Dr. Cress:

Well, here’s the catch.  As everyone knows, it’s very hard for doctors to make money because they have to see so many patients.  So, what you do this doctors going in and out, in and out in order to meet their quotas for the day.

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