Dental Sleep Medicine Insider November DSM Insider | Page 17

MEDICARE;
RANDY CURRAN
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ARE YOU PAYING IT FORWARD?
I
n a world rife with controversy
and divisiveness, I struggle think-
ing about how I can bring people
together. How can I help make
our country a better place for
my children and their children to
come? The answer is to lead by
example every day and help one
person at a time in any way I can
so my children and employees
see the man I am and hopefully
follow in my footsteps. With that
said, it saddens me when I speak
to practices about Medicare pa-
tients and the first thing they say
is “it’s not worth it, it doesn’t pay
anything.” Before I started help-
ing dental practices six years ago,
I was setting up Medicare pa-
tients with CPAP’s and BiPAP’s for
many years and watching them
struggle more than most with the
treatment.
Here they are trying to enjoy the
last years of their lives but strug-
gling to breathe when they sleep.
When you have a decorated war
veteran crying in front of you be-
cause he wants a better life but
can’t tolerate the fourth CPAP
mask he’s tried, it really hits you
hard. These patients need oral
appliances as an option more
than most because they are so
fragile and a PAP therapy just
isn’t going to work for them.
Is it going to pay as well as Unit-
ed Healthcare or Cigna? No, but
there is still sufficient reimburse-
ment to help the people who
built this great country for us. If
you’re practicing in the North-
east, Medicare and the supple-
mental/secondary will pay up
to $1,886 and you may also en-
counter a true secondary insur-
ance that will pay even higher.
In this situation, you would be
accepting assignment and an
EFT would be completed in 3-4
weeks. If you’re anywhere else in
the country, you can enroll as a
non-participating provider and
set your own fee. Medicare has
limiting charges with physicians
and other services, but not with
DME (Durable Medical Equip-
ment). The key to this is to enroll
as a Part B DME non-participating
provider and mark “NO” on the
“Accept Assignment” box on the
claim form. By doing this, you’re
telling Medicare that you didn’t
accept the allowable and reim-
RANDY CURRAN
Randy Curran is Founder and
CEO of Pristine Medical Billing. He
has spent the last 11 years bill-
ing sleep apnea and has helped
over 600 dental practices im-
plement dental sleep medicine.
bursement should be sent to the
patient. You’ll basically turn your
Medicare patient from a cash
pay patient to a cash pay with
a $1,000-$1,500 reimbursement
patient when enrolling and bill-
ing this way. The reimbursement
amount is state by state so it will
depend on where you practice.
The Medicare patient will receive
the check in this situation so they
will need to pay up front, but at
least they now have the option to
get about half of their payment
back. It’s really that simple.
We may not live in a perfect coun-
try, but it’s still the best country
in the world. We should all pay
it forward to those who gave us
these freedoms and show our
children what it’s like to respect
and honor the elderly by helping
them any way we can. Medicare
can truly be a WIN-WIN for your
patients and your practice. Pay it
forward.