Dental Sleep Medicine Insider July 2017 | Página 22

DATING ADVICE FROM A PRO Yes, you read that right. I am going to give you some real dating tips. These may not be the kind of dating tips you want, but they’re the kind you need. Once your patients have been deemed worthy or sick enough to get needed treatment, they are given the stamp of ap- proval and you are good to go, right? Well, yes and no, be- cause in most cases that green light comes with an expiration date. An approval from most plans will say “yes you meet the guidelines for coverage but only if you complete the ser- vices within a 6 week window.” It seems like just another way for insurance companies to avoid paying for claims as they can deny the claim and stamp “services provided after ap- proval date!” At GoGo Billing, we request a year but usually get a 3 month window. This potentially huge problem becomes a non-issue with just a few simple steps. 1. Have your patients commit to treatment, take impres- sions and send the case to the lab and schedule them 4 weeks out for delivery. Inform your patient you will be contacting the plan to see if a pre-autho- rization is required and if it not approved by the time their appliance comes in you may have to move them out a week or two. Not only will this dra- matically increase case accep- tance but will help when given small windows to work with. 2. Call for an extension BEFORE you deliver the appliance if the approval date has expired. Most plans will do this without an issue, but if you submit a claim and they know the ser- vices have been rendered it’s an easy denial and it will be denied. The only recourse is a lengthy appeals process. Just get the extension. 3. Don’t forget about the GAP approval. Obtaining this ex- tension is not as easy, and most plans will require a new one be submitted. These can- not be extended because a new search for an in-network LESIA CRAWFORD provider will have to be con- ducted. My best advice on a GAP approval is to again pay close attention to the dates and not get into this position. I speak on behalf of every bill- ing company when I say these dates of approval are hog- wash! Yet we have to play by the rules. Do not let insurance companies deprive your pa- tients of the treatment they need or you of the valuable production. Pay close attention, double and triple check those dates for your E0486, and remember bill on the delivery date! Lesia Crawford, CEO of GoGo Billing GoGo Billing offers help with Tri- care 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