CONTRACTING & CREDENTIALING
Coverage for oral appliance therapy is virtually always through medical, not dental insurance. Historically, reimbursement has been problematic. With accumulating scientific validation of the efficacy and effectiveness of oral appliance therapy for sleep disordered breathing, and with the endorsement of the American Academy of Sleep Medicine defining their appropriate use, barriers for insurance reimbursement are disappearing.
Typically, documentation of compliance with the practice parameters of the AASM is required for insurance reimbursement. Currently, diagnosis by polysomnogram, the overnight sleep study, is required. Once that has occurred and the patient is referred to the dentist for treatment with oral appliance therapy, insurance reimbursement should occur through the patient's medical insurance benefits.
For dependable, effective medical insurance reimbursement, the dental practitioner and the office manager must be well versed in the fundamental principles that apply. Dental and medical insurance systems are very different in their requirements for documentation, pre-authorization and reimbursement processes.
SMN will train your staff to be successful and will provide follow up support to maximize claim amounts, minimize patient out-of-pocket expenses and thereby maximize patient acceptance rates.
SMN will train the dental office staff to minimize risks of audit, provide support in the unlikely event of an audit, provide assistance in the claims appeal process and keep the dental office up to date on any changes that would affect such insurance claims activities.
A service agreement with SMN will provide:
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SMN Works® - Office Management, Electronic Medical Records (EMR) software | | • |
HIPPA compliant internet communications | | • |
Optional claims submission service | | • |
Interpretations of home monitoring data via the internet | | • |
Access to dental laboratory services from a Part 820 compliant, FDA registered medical device manufacturer, providing mandibular advancement orthotics and customized OA / CPAP interfaces. | | • |
Offsite protected storage of patient medical data | | • |
Software support via telephone | | • |
Office / Insurance Claims management support via telephone | | • |
Claims tracking | | • |
Dental / Medical clinical support via telephone | | • |
CPT / ICD-9 Coding updates - You'll likely never buy THE BOOK again! | | • |
E-newsletter update of the medical literature on important related sleep topics, and insurance reimbursement matters | | • |
Discount pricing on the Remmers Sleep Recorder, the current standard in the industry for home monitoring of patients, fully validated against PSG. | | • |
Automated progress notes, and referral letters that can be generated from templates | | • |
Marketing assistance | | • |
Sleep Laboratory Relations assistance. |
In short, there is no aspect of the medical insurance reimbursement process that SMN cannot provide for your office.
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