More dental practices are billing medical plans
today than ever before. This is due to the crossover of several
procedures that are medically necessary yet require a licensed dentist to
perform. Most notable is the oral appliance to treat obstructive sleep apnea,
often referred to as “oral appliance therapyâ€. This treatment is an alternative
to traditional CPAP and is covered by medical insurance, including Medicare.
Many
dental practices underestimate the importance of proper enrollment and network
participation options with medical
insurance before billing for dental sleep
services. It can make a significant difference when it comes to reimbursement.
Several plans may not allow a dentist to credential and
participate with their PPO or HMO medical networks or their networks may be
closed. In these situations, the dentist is considered an out-of-network
provider. As an out-of-network provider, it is important to know that a plan
still may require an enrollment application. Some Blue Cross Blue Shield Plans
will require a basic demographic enrollment while Medicare will require a
lengthy application to become a DME supplier, even if the Dentist decides to
remain “non-participatingâ€.
A third-party billing company like Lyon Dental Sleep Services in
partnership with STAT MedCare, LLC can help guide practices through this
exercise and complete enrollment applications. A credentialing process can take
3-6 months for some plans and quite a bit of paperwork and follow-up. Having a
third party manage this can save valuable staff time and resources of the
practice if they decide to go at it alone.
The oral appliance requires a prescription or “written orderâ€
from a medical provider (MD, DO, NP, and PA). This will often prompt dentists
to establish professional relationships with Sleep Specialists, PCPs, ENTs,
Pulmonologists, and Cardiologists as they often see and diagnose obstructive
sleep apnea. Typically, the first question from one of these physicians is “Do
you take medical insurance?†If the dentist answers “noâ€, this may negatively
impact the chance of that physician referring a decent volume of cases. So,
many dentists are exploring the option of enrolling and credentialing (when
applicable) with common medical insurance plans to their population/location.
The
bottom line is that any dental practice that considers offering and billing for
a medically related service should always investigate fees, enrollment, and
participation options with medical insurance plans. Some, not all, patients
have experienced an increase in their medical insurance premiums, so they are
always looking for providers who at least take or participate with their plan
to reduce out-of-pocket expenses.
https://statmedcaresolutions.com/points-pain-medical-billing/
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