Dental Sleep Medicine Insider November 2016 | Page 21

LESIA CRAWFORD MEDICARE(kinda, HASsorta, RAISED PAYMENTS* not really) ell, not really but supW plemental plans have gotten a face-lift and offices are calling wondering if they can cash these surprisingly larger payments. Let’s just say that 3 digit payments turned into 4. That’s right, a whole zero added! most certainly, DS3, were all quick to make our voices heard regarding this obvious and grave mistake. \In Dental Sleep Medicine billing, we all fear the sky is falling and before we know it, the payors will start allowing $96 for the E0486 code. In dental sleep medicine billing, we all fear the sky is falling and before we know it, the payors will start allowing $96 for the E0486 code. I Again, have not seen an inwish I was joking but it has crease with Medicare alhappened. I am hoping it lowed amounts but we have will be corrected quickly seen a shift in supplemental and there are some parties plan reimbursements and in our industry lobbying on how the plans actually function. We’ve seen FORpayments DME DEDour behalf. We all recall Aet- EXCLUSION na deciding the oral appli- totaling in the hundreds Abbreviation for “Deductible” ance is not a covered benefitUnfortunately, turn into reimbursements in we have run across for much treatment of patient OSA. isYes,some plans that have an themedical thousands. This is how money the exclusion for some or all DME supposed to spend pocketand that did out alsoof their happen supplies. When we call for a benefit until the benefit aof month insuranceAetna actually within said,verification If you have read any of my or use an online tool we starts. Some plans have doctor visits “whoopsie, never mind.” articles specifically looking concerning for the DME and preventive care available that is Asare past benefits, as they you couldmay be different a collective entity, We industry Medicare, recall not subject to the deductible. are then traditional benefits and services. not in that group;associations, for us, deductibles leaders, med- my black and white stance Medical plan has an exclusion usuallyical applybilling only to OAT. companies andIfforthe on plans. The DMEsupplemental supplies, do not assume reimbursement rule the typical representative is aware of what FAM DED specific supply you are referring of aDME supplemental plan is to. The plan may not pay for crutches only paying up to the Medi“Family Deductible” and boots but If CPAP is covered, then allowed amount. We’re OATcare should be as well. This means that each family member no longer seeing this trend. has their own deductible to meet, We have quite a few offices but there may be a limit or cap and MEDICAL NECESSITY DED, EOB, WTF?!? once it is met by any family member it starts benefits for the whole family. For instance, the plan has a $1500 This is an unknown term in dentistry but to your medical biller, this is enrolled as DME providers and we see myriad secondary and supplemental plans. When getting the benefit breakdown we started hearing “up to the billed amount” or “will cover the full patients’ responsibility up to the fee schedule.” This is great news for all of us. LESIA CRAWFORD LESIA CRAWFORD CEO of GoGo Billing GoGo Billing offers help with Tricare registration for no charge and Medicare credentialing services for DME, Part B and Ordering and Referring. Enter code DS3100 for $100.00 off DME and Part B credentialing. Contact me at [email protected] or call [phone] ext. 1. need for treatment should be listed as lifetime. DS3 has the perfect template form built right into the software