Opening a Sleep Practice? Top Questions about Medical Billing for Dentist

It is estimated, 20-25 million Americans suffer from a sleep disorder known as sleep apnea. While 200,000 new cases are diagnosed each year, it is believed 80% of those with the condition remain undiagnosed. As a dentist, you have the opportunity to help these patients receive vital treatment by opening a sleep practice. However, there are certain complications that can pose a challenge, such as the medical billing for dentist. Prior to offering treatment for sleep apnea, there are several questions you should consider.

Is Oral Appliance Therapy Covered Under Dental Insurance?

Oral appliances are among the most common options to treat sleep apnea; however, they are not billable under a patient’s dental coverage. Instead, their medical insurance is billed because they are being treated for a health condition. This creates a set of requirements, such as a doctor’s referral, and specific guidelines that must be followed in order to be reimbursed for services.

Can I Become In-Network with Medical Insurance?

Often, medical insurance companies will allow a dentist to become in-network as a medical equipment supplier. To become in-network, you will need to contact insurance companies in the area and request an application to be part of that insurance’s network of providers.

In some cases, you may not need to become in-network due to a “gap exception.” This means there is not an in-network provider for oral appliances in a geographical area. In this case, insurance companies will allow patients to use an out-of-network dentist for treatment.

Who Will Perform the Necessary Sleep Study?

A sleep study is needed to properly diagnose a patient with sleep apnea. While a physician is primarily the one to order sleep testing, some states allow dentists to offer home sleep studies. You will need to review your state’s statutes under the scope of dental practice.

How Do I Bill for Sleep Apnea?

The biggest challenge for dentists offering treatment for sleep apnea involves the billing process. The cross billing of insurances requires separate coding for each aspect of diagnosis, testing, and treatment. If the right set of codes are not used, insurance claims can easily be rejected. With multiple steps needed for an insurance claim to be approved, it can lead to a great deal of headache and hassle for dentists.

Many dentists have now made the choice to outsource their billing for sleep apnea. Outsourced medical insurance billing for dentist increases accuracy for faster approvals with less rejections. This not only simplifies the entire process but also saves your office valuable time dealing with insurance claims. As a result, you are able to better allocate your time elsewhere.

Where Can I Get Outsourced Insurance Billing?

Brady Billing offers insurance billing services for dentists treating sleep apnea. We handle the entire process, including verification, authorizations, and determinations. We help with the denial and appeals process while also managing fee negotiations. Overall, we streamline the entire process for increased accuracy and efficiency.

If you are ready to open a sleep practice, contact Brady Billing today to discover how we can help your practice with insurance billing.