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Medical Billing 101

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During the early stages of a business, the owners typically find themselves handling every area of their businesses, leading to an overwhelming amount of burnout. While dental sleep medicine has the potential to transform dentists’ lives, many of them walk away believing it ‘doesn’t work’. 

One of the reasons dentists walk away from sleep feeling defeated is the billing and reimbursement process. Medical billing can be a complicated process to undertake, even more so when the dentists themselves are left to do it on their own. In their general dentistry practices, dentists usually have at least one staff member dedicated to billing, but when they go into dental sleep medicine, they process the reimbursements themselves. 

The problems stemming from sleep dentists doing their own billing come from incorrect reimbursement submissions. Dentists then become frustrated when their oral appliance reimbursement claims are denied for not being correctly submitted and start to think sleep isn’t worth it. 

What’s worse, sometimes dentists will get their claims approved shortly after submission, only to be audited at a later date and forced to return their reimbursement payout. After repeatedly experiencing these pitfalls, it’s no wonder dentists become disillusioned with dental sleep.

But it doesn’t have to be this way.

Say goodbye to denied reimbursement claims

If dentists don’t do their own general dentistry billing, why do it for dental sleep? 

Imagine if patients began to go to their plumber for dental treatments. Plumbers are skilled workers, sure, but not in dentistry. So why should dentists do their own billing when the process requires a fair amount of knowledge and skill of its own?

The solution to this problem is outsourcing the billing and reimbursement process to a professional medical billing company. 

These companies have experts in medical billing dedicated to properly submitting paperwork, so dentists and doctors don’t have to deal with it on their own. They’re familiar with all the codes, guidelines, and requirements for paperwork and reimbursements. 

Dental sleep can change a dentist’s life, but it shouldn’t be done alone – here are some reasons to hire a professional medical billing company to do your billing and reimbursement forms — and when it comes to medical billing for dental sleep medicine, the field narrows quite a bit.

Insurance companies require thorough documentation

In any medical field, keeping proper documentation is important, and it could not be truer than in dental sleep. Dealing with insurance companies is never an easy process, whether you’re the healthcare provider or patient, but it can be less of a headache if the proper documentation is submitted when requesting reimbursement. 

For instance, one of the reasons that sleep dentists get their reimbursement claims denied is the absence of ‘proof of appliance delivery’, like the receipt the patient receives when they pick up their oral appliance. The dentist may not realize that while the patient should have a copy of the delivery slip, they should have their own to submit to the insurance company, so they’re aware the delivery was made.

The delivery slip is only one example of the extensive amount of paperwork that needs to be submitted to the insurance companies for reimbursement, and on top of treating their sleep patients, many dentists still have their general dentistry patients to treat. It can be quite difficult for a single person to stay on top of making sure the proper documentation is submitted. 

Keep in mind that between diagnosis and ordering an oral appliance, it’s imperative to consider any prior authorization paperwork requirements from insurance companies before they proceed with oral appliance therapy. Failure to do so can prevent a payer from covering the patient and can impact your ability to get reimbursed properly.

Of course, different insurance companies require different documentation, and it’s up to the dentist to know who requires what. And this isn’t taking Medicare into account, which has its own requirements for reimbursement. 

Having a professional medical billing company that really understands sleep that handles all the documentation gives dentists more time to treat their patients and give them the peace of mind of knowing that they don’t need to stay up to date with the constant changes to insurance requirements.

Getting reimbursement for an oral appliance can take a long time 

The time it takes to get reimbursed by insurance companies is longer than most dentists would like, and that can be discouraging.
It takes an average of 42 business days to get paid for the oral appliances per patient, and it can take much longer without the right approach. 

This process requires the sleep practice to call the insurance companies at least 4 times per patient, totaling around 10-16 hours on the phone!

You have to continually call the insurance companies to follow up with the claim, because you aren’t the only one filing a claim and they can get backed up. While understandable, it may not matter to the vendors whose invoices you need to pay – you need to get paid on time. 

Imagine what you could accomplish by winning back 10-16 hours of valuable time for every patient you have?

Keep in mind this isn’t taking into account all the time you have to spend making sure your documentation is perfect, resulting in a clean claim. This is where a professional medical billing company would excel. 

Not only would the company make sure your documentation is in line with what the insurance company requires, but they’d be the ones calling them every few weeks to follow up on the claim until it gets paid out. 

Remember, you’re not going into dental sleep to spend hours on the phone with insurance companies, you’re here to help people lead healthier lives through better sleep. 

The tiniest of errors can result in a denied claim

After submitting all your patient’s documentation and spending hours on the phone with their insurance, your claim can still get denied over the smallest error. 

For example, if your patient has a middle name on their oral appliance delivery slip and they don’t have one on their insurance records, the claim can get denied. It can also be denied if you mess up the date on the claim, even by a single day. 

Making sure you have all the information correct can be stressful, and sometimes no matter how many times you look over the claim, there might be an error that will simply slip through the cracks. 

It’s also possible these errors aren’t caught immediately. Many dentists have submitted their paperwork, had it approved, and received their reimbursement payout. The problem? Later on down the road, they get audited, and it’s discovered they didn’t submit their paperwork correctly, and are then forced to return the reimbursement. This isn’t something dentists want to experience while all they’re trying to do is help their patients breathe through the night. 

A professional medical billing company takes the hassle out of having to pore over stacks of documents with tired eyes to make sure you haven’t made a single mistake. A medical billing company knows what mistakes get made the most, and will prevent these mistakes from getting through to the insurance companies. Having professionals take care of the most tedious aspects of dental sleep gives you more time to screen, diagnose, and treat your patient. 

Let a professional medical billing company do the hard work for you

The medical billing process for oral appliance reimbursement may seem overwhelming at this point, but you don’t have to do this alone. You may not even have to do this at all if you hire a professional billing service. The most successful dental sleep professionals don’t do sleep alone, they have a supportive team behind them. And while you may not be able to bring on a full team to your sleep practice yet, outsourcing your billing could be an incredible first step in that direction. 

IAOS members have access to an extensive network of dental sleep support professionals including medical billing companies that we’ve personally vetted and are proud to partner with. IAOS takes the guesswork out of finding a medical billing company that fits your practice and in turn, they take the hassle out of your billing struggles. 
Curious about what else IAOS has to offer? Read our free book Blue Ocean and schedule a call with our Director of Customer Relations, Heather Wallace at heather@iaos.com

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