How Do You Document Dental Sleep Apnea Cases in the Medical Model? 

It’s estimated that one in 15 adults in the United States has obstructive sleep apnea, which is about 18 million people. Approximately 80% of these people are undiagnosed. Although men are at a higher risk of sleep apnea than women, both sexes can suffer from this disorder. 

If you are not currently billing medical insurance for treating your sleep apnea patients, you could be limiting your patient numbers and practice growth. Successfully receiving medical reimbursement for sleep apnea may seem challenging, but with the right knowledge and an adequate system in place, it becomes easy.  

Implementing medical billing in the dental practice can provide an increase in more patients being able to afford treatment. There are several factors for successfully obtaining medical reimbursement for dental sleep medicine, but the most critical one is typically proper documentation. 

For successful documentation for dental sleep medicine oral appliance therapy, you must first: 

Have the right questionnaire to show “Medical Necessity.” 

A questionnaire must be put in place to identify the key findings to build a case of medical necessity. Questionnaires must include specific information and language with the key information that insurance companies look for. Excessive daytime sleepiness, witnessed apneas, head and facial pain, difficulty masticating, chronic mouth sores, infection, problems with function, snoring, and cessation of breathing are examples of what should be on the questionnaire. Before an insurance company even considers a claim, they will need thorough and detailed documentation using the correct language and terminology showing that the patient is medically compromised. A medically compromised patient is a client whose health status, as determined by appropriate provider staff in accordance with accepted standards of practice, is likely to change or has changed because of a disease process, injury, disability or advanced age, and underlying disease process(es). Since so many people are undiagnosed with sleep apnea, a proper questionnaire is the perfect diagnosis tool to help people get the treatment they need to improve their quality of life. Consequently, the dental practice can receive authorization for medical insurance reimbursement. 

What specific information do I need? 

When billing sleep apnea to medical insurance, they want to know information such as, “Did the patient refuse CPAP?” Or “Is the patient CPAP intolerant?”  Asking the right questions upfront makes all the difference. You should also include the Upward Sleep Questionnaire. This is how most insurance companies determine the level of excessive daytime sleepiness. With successful dental to medical billing for sleep apnea, you will find that the insurance companies are not just looking for patient drugs or occlusal problems. This all must be documented as a SOAP report in the medical model.  “SOAP” stands for Subjective questionnaire, Objective exam, Assign Diagnosis- (ICD-10) Codes, Plan (CPT procedure codes). The SOAP report is an accumulation of the sleep patient questionnaire, documentation from other doctors, and their overall score written as a narrative report.  With the documentation and structure in place right off the bat, you can save time and energy. Receive a faster medical billing insurance approval rate for your dental procedures that are medically necessary by having the proper documentation.

Nierman Practice Management can assist you in acquiring the knowledge and tools to successfully bill dental to medical insurance, with a proven 33-year track record in the industry.  If you are not using it already, NPM just released DentalWriter Plus+,  a web-based cloud EMR software designed exclusively for dental practices treating sleep apnea, TMJ disorder, and oral surgeries to streamline the medical billing workflow needed for effective practice growth. 

Utilizing EMR software is the most convenient and advantageous way for a dental practice to document and create the narrative report specifically aimed for approval from a medical insurance company for dental procedures and treating sleep apnea.  

Successful reimbursement tip

Asking the patient if they are CPM intolerant or have refused CPAP is very important. A lot of insurance companies say if it is mild sleep apnea, has tried dieting or weight loss, they will pay. Another thing commonly seen in policies is yes, insurance companies will pay if the patient has tried positional therapy first. Additional questions about sleep history, as well as any other treatments, are also necessary.  

Most importantly, the dental practice must send the narrative reports to other healthcare practitioners or the referring doctor.  This optimal communication between all doctors is necessary not only for optimal treatment for the patient but to keep all the documentation organized and up to date for successful reimbursement.   

Not satisfied with your current medical billing service? 

If you are unhappy with your current medical billing service and software, Dental Writer Plus+ is the latest cloud-based technology of an accumulation of years of experience in successful dental to medical billing. The intelligently designed automatized system supplies the online questionnaire with everything the patient needs to answer for a thorough exam proving medical necessity, in the medical model. After your exam, DentalWriter Plus+ autogenerated the narrative report in SOAP format, exactly what the medical insurance needs to approve your claim. Additionally, the medical billing concierge service has an instant chat available, and you can check the status of your claim online.  DentalWriter Plus+ makes it easy to communicate with sleep doctors and have all your documentation organized, and your ducks in a row for more medical billing insurance approvals.  

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