Dental Sleep Medicine Insider September 2017 | Page 5

RANDY CURRAN
AVOID THE TRAFFIC JAM!
EXPRESSWAY TO END OF YEAR COVERAGE
O
ver the past 11 years that
I’ve been billing for sleep
medicine, there have been
few times where history re-
peats itself. One of them is the
mad rush of authorization re-
quests in November and De-
cember. It seems the whole
country is trying to get some
type of treatment done before
their deductible and maxi-
mum out-of-pocket resets
for the next calendar year.
I can’t begin to tell you how
many authorization requests
I see submitted in December
that don’t get approved until
January. The insurance com-
panies are overloaded and
unfortunately, they aren’t in
a hurry to expedite the pro-
cessing of these requests.
Although the authorization
may be good from the date it
was requested rather than the
approval date, the practice
may not know this in time to
deliver before the end of the
year. You may think, “Well, I’ll
just use the impression date”.
WRONG.
I strongly advise you to use
the delivery date. We are
seeing a trend of insurances
asking for the signed proof of
delivery as they do with other
4 Tips to Become Proactive & Efficient:
1. Beat the crowd when possible - start in October.
2. Circle back with any patient that didn’t move forward with
treatment…benefits may have changed!
3. Re-check their benefits or at minimum recheck their
accumulations through your DS3 software to gauge if their
deductible or even better, max out of pocket has been met.
4. Don’t forget to check both individual and family
accumulations.
DME equipment. BE CAREFUL.
Want to take it a step further?
Ensuring the insurance car-
riers have all the documen-
tation they need up front
helps avoid delays and poten-
tial denials when requesting
pre-authorizations, pre-de-
terminations and gap ap-
provals.
This extensive documenta-
tion will help you jump into
the fast lane:
1. Qualified Diagnostic
Sleep Test: Avoid delays by
ensuring that the sleep test
results are the diagnostic
study rather than a CPAP ti-
tration study.
2. Thorough Medical
RANDY CURRAN
Randy Curran is Founder
and CEO of Pristine Medical
Billing. He has spent the last
11 years billing sleep apnea
and has helped over 600
dental practices
implement dental sleep
medicine.