May 2019 DSM Insider 32 - Page 18

LISA FISCHER -HERDT YOU NEED TO KNOW THIS STUFF MEDICARE, DIGITAL SCANS, DOCUMENTATION, & KENTUCKY WEATHER T he weather in my home sweet home state of Kentucky and the world of medical insurance have one thing in common. Both seem to change about every 24 hours. Maybe that’s why I’m drawn to medical billing... but that wouldn’t explain why I got the heck out of KY and moved to FL. Oh, nevermind. Well, the winds of change continue to blow. If you have a reliable 3rd party billing partner OR a team member that keeps their finger on the pulse of the industry, then you’re likely already privy to the info below. If you don’t, well, hear ye, hear ye…. Medicare gives “green light” to digital scans for OAT fabrication Something so obvious shouldn’t even require an update like this, but it did. Until recently, according to Medicare, Oral Appliance Therapy would only be covered if the device was fabricated from analog impressions. Fortunately, that has changed. Below is the update from the DME MAC’s: “In late February, the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Directors released a letter regarding whether digital techniques of teeth impressions could be used to generate a physical model for an oral appliance (OA). The DME MAC Medical Directors clarified that digital scanning can be used as long as physical models are still created, which are then used to custom fabricate OAs.” Medicare will be updating the specific LCD (Local Coverage Determination) in a future revision but has not yet determined a date. You can use the following link LCD Article A5212 for your reading pleasure. Next, is just a friendly reminder that you should follow the LCD regulations regarding device selection, correct coding, and proper documentation. If It Isn’t Documented, It Didn’t Happen Nothing has changed here. This axiom should be tattooed in your brain. Your notes should paint a clear picture about your patient encounters. You want Caravaggio here, not Picasso. And you cannot forget about the Proof of Delivery (POD). Also note that in some instances commercial carriers are requiring a lab invoice as well. Change is inevitable. It is imperative that you have a resource that can guide you to stay in the know. Let me know how I can help. According to Medicare, not all devices are created equally. PDAC approved devices must be custom fabricated, fixed hinge devices such as the TAP, Herbst, and Snorehook. Correct coding for the device must be E0486 for coverage consideration. Codes such as E0485, which is a prefabricated oral device, and A9270 which includes a snore guard and a tongue repositioner will result in a denial of coverage for the patient which will yield no reimbursement. LISA FISCHER-HERDT Lisa is the Director of Member Communications at Dental Sleep Solutions and 4 Pillar Billing. She has over 15 years of Medical Billing experience and serves on the Manatee Tech College Advisory Board.