Dental Sleep Medicine Insider September 2017 | Page 6

RANDY CURRAN
History: Include detailed
clinical notes: high blood
pressure, history of stroke,
heart disease, pulmonary hy-
pertension or disease, mood
disorders such as depression,
anxiety, etc.
3. Sleep Questionnaire:
Include proof of exces-
sive daytime sleepiness and
whether the patient suffers
from insomnia, mood disor-
ders, witnessed apnea, chok-
ing and gasping resulting
in
waking,
morning
headaches
and nocturnal
urination.
(An Epworth
score at 10 or
higher is the
easiest way to
qualify a mild
sleep apnea
patient. The
DS3 Screener
does an excel-
lent job cap-
turing this in-
formation.)
4. Recommendation for
Oral Appliance Thera-
py: Be sure that your sleep
test results include this rec-
ommendation on the sum-
mary page, collect an Rx or
a letter of medical necessity
from a medical doctor.
5. CPAP Intolerance Form:
Document and include this
form if the patient is severe
or has tried, but failed CPAP
in the past. Even if the patient
isn’t severe or if they have
not tried CPAP in the past, the
form could be completed…
mark “other”, stating the pa-
tient prefers oral appliance
therapy. This helps expedite
the billing process by telling
the insurance carrier what
their member wants as first
line treatment.
6. Added Value: An in-
creasing number of insuranc-
es are asking for information
regarding the patient’s teeth,
gums, and joints. They are
requiring information that
the patient has an adequate
number of teeth to support
the appliance, lack of peri-
odontal disease, and that the
TM joints are within normal
limits. Plug these things in
and get results. Last time I’ll
say it; DS3’s exam templates
help you easily & efficiently
capture this information.
Stay on the gas, be on top
of pending authorizations.
Whether it’s the end of the
year or not, the best way to
get authorizations and/or gap
approvals quickly is to call
on status every 3 days to en-
sure the insurance has what
they need. This is essential to
speeding up the process.
Another word of advice…
be careful when requesting
sleep tests in December. If
the patient does a sleep test
in December, it may be un-
likely that the pre-authoriza-
tion and/or gap approval, and
delivery of the appliance are
all completed prior on time. It
is highly ben-
eficial for the
patient and
your practice
if your test-
ing and ther-
apy land in
the same cal-
endar year.
That said, do
not postpone
your patients’
healthcare
because
of
their insur-
ance.
In summary, start now and
stay on the gas to beat the end
of the year traffic. Help lead
more patients to treatment
by understanding the status
of their benefits toward the
end of the year. Be diligent
about clinical records and
getting them to the insurance
carriers ahead of time. This
advice will allow you to help
additional patients and cap-
ture insurance reimburse-
ment during the optimal time
of year.