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 (877)874-4646 ext. 1.
need for treatment should be listed as
lifetime. DS3 has the perfect template
form built right into the software