Nierman Practice Management https://niermanpm.com Dental Sleep Medicine Software & Dental-to-Medical Billing Services and CE Courses Fri, 12 Mar 2021 21:14:01 +0000 en-US hourly 1 https://wordpress.org/?v=5.8 https://niermanpm.com/wp-content/uploads/NPM-favicon-150x150.png Nierman Practice Management https://niermanpm.com 32 32 Get Custom-Oral Sleep Appliances Paid by Medical Insurance https://niermanpm.com/blog/what-you-need-to-get-custom-oral-sleep-appliances-paid-by-medical-insurance/ https://niermanpm.com/blog/what-you-need-to-get-custom-oral-sleep-appliances-paid-by-medical-insurance/#respond Thu, 11 Mar 2021 18:57:34 +0000 https://niermanpm.com/?p=229066 A guide to documentation requirements for oral appliance therapy for sleep apnea The great news is medical insurers consistently offer coverage for custom-made oral sleep appliances for patients suffering from Obstructive Sleep Apnea (OSA)…. even Medicare! That is right – medical insurance, not dental! Although custom-made oral appliances (HCPCS code E0486) for OSA (ICD-10 code […]

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A guide to documentation requirements for oral appliance therapy for sleep apnea

The great news is medical insurers consistently offer coverage for custom-made oral sleep appliances for patients suffering from Obstructive Sleep Apnea (OSA)…. even Medicare! That is right – medical insurance, not dental! Although custom-made oral appliances (HCPCS code E0486) for OSA (ICD-10 code G47.33) are provided by dental practices, they are covered by a patient’s medical insurance because they are considered medically necessary services/equipment provided in the dental practice setting. The question is: what all is needed for successful reimbursement?

There are 3 standard items across ALL medical insurers that are always required:

1. The patient’s sleep study report

Sleep Study Report

Medical insurers typically only cover a custom-made oral sleep appliance if the patient is diagnosed with OSA – either mild (AHI 5-15), moderate (AHI 15-30), or severe (AHI 30+). Currently, the only way to diagnose OSA is through a sleep study, so a copy of the sleep study report is always required to provide the diagnosis of OSA. We have seen a *few* medical insurers state in their coverage policies that Upper Airway Resistance Syndrome (UARS) may be covered when attempts at behavioral modification have been tried & failed, however that is currently rare. It is also rare to see coverage if the diagnosis is primary snoring vs sleep apnea.

2. A prescription or written order from a physician

Custom-made oral sleep appliances for OSA are categorized as Durable Medical Equipment (DME). As with most DME, the majority of medical insurers require a physician’s written prescription/written order (“physician” is typically defined as MD, DO, NP PA, or CNS working within their scope of practice). The written prescription to the dentist requests that a custom-made oral sleep appliance be provided to treat OSA. To make it simple to document, there is even a field on the medical claim form to indicate the referring/ordering physician’s name and NPI number! (field 17).

3. Clinical/SOAP notes from the dentist’s evaluation

dentalwriter, soap notes,medical billing in dentistry

The clinical notes, preferably in SOAP format (subjective, objective, assessment, plan) are extremely important for several reasons. One scenario is an increasing trend we have seen developing over the last year or so – many medical insurers are now stating in their coverage policies that for a patient to meet coverage criteria for a custom-made oral appliance for OSA, the dentist’s evaluation notes must include that the patient is free from active periodontal disease and active TMJ disorders.

Another scenario would be if the patient is diagnosed with mild OSA – many medical insurers require that if a patient is diagnosed with mild OSA, in order to meet coverage criteria for a custom-made oral appliance they must have at least one comorbidity of OSA documented in their medical history (the subjective section of the clinical notes). The items necessary to document include symptoms of problems including excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease, or history of stroke.

There are 3 other items we see extremely frequently, so it is a great idea to always have these on file so you have them handy if the medical insurer requests them:

1. Clinical notes from treating/ordering physician

The clinical notes from the treating/ordering physician are another growing trend we have been noticing over the last year or so. For example, United Healthcare’s medical policy lists as part of their coverage criteria that “a patient presenting with symptoms of OSA be seen in a face-to-face evaluation with a qualified physician (MD or DO) trained in sleep medicine prior to beginning treatment for OAT”. The medical policy goes on to state in further coverage criteria “If the patient refuses CPAP therapy, documentation of the refusal from the patient’s treating physician (MD or DO) must be supplied”.

2. Proof of delivery form

Proof of delivery is a standard piece of documentation in the DME medical billing realm. This is a form signed by the patient (or tracking information if the item is shipped) to prove that the patient actually received the equipment/item. Due to a long history of fraud in DME medical billing, custom oral appliances for OSA should not be billed to the medical insurer until the patient has the appliance in their possession (in other words, the date of service on your medical claim will not be the date of impressions, it will be the date of delivery). The proof of delivery form is also essential for documentation since some medical insurers only offer coverage when the appliance used is PDAC approved (aka Medicare-approved) for the medical billing code, E0486. These appliances can be viewed at www.dmepdac.com by searching code E0486 in the product classification list option.

3. CPAP/PAP therapy affidavit of refusal or intolerance/noncompliance

Man with a CPAP appliance for sleep apnea adherence

When a patient is diagnosed with severe OSA, most medical insurers require documentation that Continuous Positive Airway Pressure (CPAP/PAP) therapy has been tried and failed, the patient refused this therapy or CPAP/PAP therapy or the physician determines that therapy is contraindicated prior to coverage being offered for a custom-made oral appliance. The guidelines pertaining to the PAP therapy trial vary. For example, some medical insurers require a 30 or 45-day trial, while others do not specify any specific time period. Additionally, some medical insurers will accept a specific form signed by the patient (CPAP/PAP affidavit of intolerance/non-compliance), while some medical insurers require documentation from the physician as we see in United Healthcare’s medical policy mentioned above stating “If the patient refuses CPAP therapy, documentation of the refusal from the patient’s treating physician (MD or DO) must be supplied”.

Having a system in place to gather information, store, and create SOAP reports is key for a streamlined & successful protocol. Nierman Practice Management’s DentalWriter software helps practices implement dental sleep medicine & medical billing by generating SOAP reports and medical claims to successfully work with their patient’s medical insurance. With the right tools, you can be confident that your documentation ducks are in a row!

Article by: Courtney Snow, Nierman Practice Management


Contact Us

Please feel free to contact us with any questions related to this article. We host a variety of online and live courses for dentists, including topics such as dental sleep medicine, TMJ, craniofacial pain, and medical billing in dentistry. We also have a comprehensive, online course series for medical billing in dentistry. For more information, contact Nierman Practice Management at 1-800-879-6468 option 1, by sending us an email at contactus@dentalwriter.com or by visiting niermanpm.com.

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Overcoming 5 Common Challenges When Implementing Dental Sleep Medicine https://niermanpm.com/blog/-overcoming-5-common-challenges-when-implementing-dental-sleep-medicine/ https://niermanpm.com/blog/-overcoming-5-common-challenges-when-implementing-dental-sleep-medicine/#respond Tue, 09 Mar 2021 19:40:21 +0000 https://niermanpm.com/?p=229051 We help thousands of dental practices successfully implement Dental Sleep Medicine (DSM) and sleep apnea appliances into their practice. Some dental practices have implemented DSM so successfully that dental sleep is the only thing they do now! It is not always smooth sailing, as with most new services introduced into a dental office. With that in mind, […]

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We help thousands of dental practices successfully implement Dental Sleep Medicine (DSM) and sleep apnea appliances into their practice. Some dental practices have implemented DSM so successfully that dental sleep is the only thing they do now! It is not always smooth sailing, as with most new services introduced into a dental office. With that in mind, we wanted to share the five most common challenges dental practices face when implementing dental sleep medicine and how to overcome these obstacles 

1. Medical Insurance  

Medical documentation is a challenge when implementing dental sleep medicine

Medical coding, billing, and documentation prove to be the most frequently mentioned challenge that dental practices encounter when implementing DSM. The good news is medical coding, billing, and documentation are not difficult; it is simply different than dental! Keeping that in mind, the best way to avoid this challenge is to educate the billing team on best practices for coding, billing, and proper medical documentation. Even if your ultimate choice is to outsource the medical billing to a third party, it is nonetheless vital that your dental team become familiar with medical billing basics to ensure ethical and appropriate execution of your medical billing process. Beware of heeding bad advice from organizations or individuals who do not have your long-term best interest in mind. Nierman Practice Management offers exceptional medical billing in dentistry seminars with both live and virtual attendance options 

2.  Team Buy-In  

dental team on board for implementing Dental Sleep Medicine

We have heard so often over the years that “we could provide so many more sleep appliances if only my team would get on board.” We get it. Having both your administrative and clinical dental team on board is crucial for implementing Dental Sleep Medicine. So, what is the best way to overcome this challenge? We believe this to be a multi-pronged approach. Consider educating the entire team on their new responsibilities. More importantly, educate your team on WHY screening & treating patients for sleep-disordered breathing issues is essential to a patient’s day-to-day mental, physical, and emotional well-being. Be sure that your team is comfortable discussing treatment and expectations with patients from the very first phone call through long-term maintenance care. Consider making your team members a sleep appliance of their own (or one for their significant other), so they talk to patients from first-hand experience and cultivate the passion for the life-changing results that can occur 

3. Sleep Testing  

Sleep tests are a challenge for implementing dental sleep medicine

Currently, the only way to confirm Obstructive Sleep Apnea (OSA) diagnosis is through an overnight sleep study (polysomnogram). The majority of medical insurers allow for sleep studies to be performed in a sleep lab or with home sleep testing units, depending on the patient’s condition. Several challenges can arise with this process: patient pushback on being tested, finding an appropriate sleep testing site, and medical insurance & dental state board considerations for who can recommend and perform the sleep study, to name a few. To overcome this challenge, we recommend effective communication with treating physicians to build mutually beneficial referral relationships. When deciding the best route for obtaining the diagnosis, consider your patient population and your available local & virtual sleep testing options. It is crucial to bear in mind that many medical insurers will require that the patient be seen face-to-face by a physician either before the sleep study, or before placing a custom-made oral appliance for OSA (i.e., Medicare, United Healthcare). Working with local physicians or a virtual service that offers face-to-face virtual telehealth visits becomes essential in these cases.  

4. Physician Referrals  

While screening and treating your already established patient base is a wonderful way to get started in DSM, generating referrals from the surrounding medical community is pertinent to ongoing growth and success. Some dental practices we have worked with over the years reported difficulty “getting connected ” to the local medical community. To overcome this challenge, we recommend medical community outreach. You may be surprised to find that sleep physicians are not always the top referral sources for our most successful DSM practices! Consider other provider specialties that frequently encounter patients suffering from sleep-disordered breathing, such as cardiologists, pulmonologists, neurologists, ENT’s, psychiatrists, and primary care physicians. Here is a little-known tip as well: many medical insurers will accept prescriptions for oral appliance therapy for OSA not only from MD’s and DO’s, but also from PA’s, NP’s, and CNS’s working within their scope of practice! PA’s, NP’s, and CNS’s are typically more accessible to contact, and they spend plenty of face-to-face time with patients. Schedule a call, zoom meeting, or lunch and learn for medical practices in your patient population areas to learn more about them, and let them know you offer oral appliance therapy for OSA. Reassure physicians and their team that you refer the patient back to their office once oral appliance therapy is showing subjective improvements. Also, state that you will be screening your own patient base as you are looking for medical practices to refer to as well.  

5. Patient Acceptance of Treatment  

Patient Accepts treatment for dental sleep medicine

What is the trick of the trade to get the patient to say “yes” to treatment? Well, there is not a magic bullet. However, we have identified common traits amongst the most successful DSM practices that are the recipe for a high rate of success—first, having a knowledgeable & confident team that is comfortable discussing treatment with patients. The patient may already be wary that they are visiting a dental practice to address a medical issue, so be sure your team can switch out of their “dental pants” and put on their “medical pants.” Second, focusing on the patient’s chief complaints will help the patient understand you want to help them solve problems associated with their OSA. We like to call this the patient’s “hot button issues.” For example, if the patient’s primary reason for seeking treatment is excessive sleepiness during the day that affects their job or personal relationships, inform the patient that reducing the severity of or resolving OSA can significantlimpact their quality of sleep and energy levels positively. Gathering patient testimonials (video testimonials, preferably!) from successfully treated patients is a beautiful way tshowcase your successful outcomes. Lastly, working with the patient’s medical insurance to help reduce the patient’s out-of-pocket cost (or at leasutilize their medical benefits) is essential 

 While the journey to implementing dental sleep medicine into your dental practice may not be a walk in the park, these solutions to the top five challenges will undoubtedly help you avoid some pitfalls along the way for a smoother stroll 

Article by: Courtney Snow


Contact Us

Please feel free to contact us with any questions related to this article on Implementing Dental Sleep Medicine. We host CE courses on Medical Billing for Dentists and clinical treatment of TMD disorders and Dental Sleep Medicine. For more information, contact Nierman Practice Management at 1-800-879-6468 option 1, by sending us an email at contactus@dentalwriter.com or by visiting niermanpm.com.

Learn More

We have a variety of online and live courses for dentists, including topics such as dental sleep medicine, TMJ, craniofacial pain, and medical billing in dentistry. We also have a comprehensive, online course series for medical billing in dentistry.

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How Dentists Can Estimate Out-of-Pocket Costs to Patients when Billing Medical Insurance https://niermanpm.com/blog/how-dentists-can-estimate-out-of-pocket-costs-to-patients-when-billing-medical-insurance/ https://niermanpm.com/blog/how-dentists-can-estimate-out-of-pocket-costs-to-patients-when-billing-medical-insurance/#respond Tue, 01 Dec 2020 19:20:22 +0000 https://niermanpm.com/?p=15663 “How much is this going to cost me?” Sound familiar? This doesn’t always need to be a difficult or dreaded conversation! In fact, it is a wonderful opportunity to gain trust and confidence with your patients by helping them understand their medical insurance benefits, which may have never been explained to them before.    For dental practices billing their patient’s medical insurance as out-of-network providers, […]

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“How much is this going to cost me?” Sound familiar? This doesn’t always need tobe a difficult or dreaded conversation! In fact, it is a wonderful opportunity to gain trust and confidence with your patients by helping them understand their medical insurance benefits, which may have never been explained to them before.  

For dental practices billing their patient’s medical insurance as out-of-network providers, the answer to this question may not be straight forward for the first couple of claims. The reason for this is because commercial medical insurers do not typically reveal the dollar amounts or their Usual, Customary and Reasonable (UCR) fees that they “allow” for services paid to out-of-network providers!  However, once you start billing medical claims for sleep apnea appliances, oral surgeries, CBCTTMJ splintsexams, etc., estimating benefits becomes easier. Although medical plans vary, you can estimate future allowed amounts after having processed a claim or two. That allowed amount is revealed on the Explanation of Benefits (EOB) received after the claim is processed. 

We wanted to share some tips to help this conversation go smoothly and stay positive from Nierman Practice Management! 

 1. Verify medical insurance benefits prior to the appointment when possible. 

Verifying benefits

By verifying the benefits prior to the appointment, this allows you to have the information to begin this discussion. Although you may not know exactly what the medical insurer is going to allow for the services you render just yet, you will be able to confirm the remaining deductible amounts and co-insurance percentagesPrevious EOB’s will help you create an out-of-pocket estimate for future cases 

2. Use positive language, confidently.  

Rose Nierman confidently using positive language

When a patient asks if the service is covered by insurance, use positive language such as “Great news! – Yes, many patients can use their medical insurance benefits to help cover the costs of treatment. This means you can save your dental insurance benefits for dental procedures that are not covered by medical insurance.” 

3. Break the costs down into bite-sized pieces. 

Anjoo Ely break the costs down into bite-sized pieces

Instead of overwhelming the patient with a large amount, break costs down into a monthly or even daily cost! For example, if you are talking to the patient about a custom-made oral appliance for sleep apnea, instead of saying “We are estimating your out-of-pocket expenses to be $1200” try saying“these appliances typically last for 5 years, so for the equivalent of about $20 a month, or $0.66 per night, this therapy can help you sleep and breathe better”.   

4. Be sure the patient understands the deductible. 

Rose Nierman Be sure the patient understands the deductible  

No one likes deductibles, but if the patient does still have deductible remaining, it can only be waived in cases where there is a true, documented financial hardshipEven if a large amount of your treatment fee will be applied to the deductible (meaning the patient pays you that amount out-of-pocket), you should present this as a positive to the patient. “Once this claim processes, your deductible is met for the remainder of the year!.” 

To help make treatment more affordable, dental practices should offer patients financial options such as payment & financing plans (i.e., care credit).  It behooves the dental office to work with their patients’ medical insurance, whether on their own or with the help of a third party (some dental practices outsource medical billing to companies such as Nierman Practice Management) for procedures that may be considered medically necessary.   

The more options that are presented to help finance lifechanging treatments such as sleep apnea appliances, TMD treatment, oral surgeries and other procedures, the more likely patients can get treated. Billing medical insurance from a dental office is not hard, it’s just different than dental insurance.  And what is more worthwhile than helping patients get the treatment that they need? 

Article by: Courtney Snow, Nierman Practice Management

Learn More

See upcoming dental courses in medical billing for dentistry (available in-person or livestream)

Or

Our new self-paced online dental courses for medical billing-in-dentistry.

Our renowned courses will help you become a successful dental-to-medical biller for dental sleep medicine, TMJ, implants, frenectomies, oral surgeries, and more. Happy cross-coding!

Contact Us

Please feel free to contact us with any questions related to this article on patient’s out of pocket costs when billing medical insurance-in-dentistry. Send us an email at contactus@dentalwriter.com or call 1-800-879-6468 option 1.

About: Nierman Practice Management

Nierman Practice Management is the leader in dental-to-medical billing and cross-coding solutions for dental practices.

They have been helping dental practices expand into medical billing, sleep apnea treatment, & TMJ/orofacial pain since 1988, with innovative technology platforms, training, and medical billing services. Their proprietary DentalWriter Software is the leading dental practice management system for narrative report and medical billing.

 



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Outside Lab Field #20 on a Medical Claim Form https://niermanpm.com/blog/outside-lab-field-20/ Tue, 03 Nov 2020 13:00:52 +0000 https://niermanpm.com/?p=13524 Outside Lab is field #20 on a medical claim form. This field can be misleading if you’re not familiar with when to say “yes” or “no”, resulting in delays or even denials of your medical claim. In her latest vlog, Rose Nierman explains when and when not to use the Outside Lab, Field #20. Rose’s […]

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Outside Lab is field #20 on a medical claim form. This field can be misleading if you’re not familiar with when to say “yes” or “no”, resulting in delays or even denials of your medical claim. In her latest vlog, Rose Nierman explains when and when not to use the Outside Lab, Field #20.

Rose’s Rules is a video blog series from Nierman CE+. Nierman CE+ is an online learning platform for dentists and dental practices. The platform hosts the most comprehensive suite of self-paced courses for medical billing in dentistry online. Developed and led by cross-coding icon, Rose Nierman, each course covers what you need to know about billing medical insurance for sleep apnea, TMJ disorders, and oral surgery.

To learn more from Rose, Nierman Practice Management also hosts many live and virtual courses in cross-coding and medical billing. Thousands of dental practices have attended a Nierman CE course in medical billing, sleep apnea, or TMJ disorders. To learn more about our upcoming courses, both live and virtual, check out our schedule page here.

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3 Key Steps for Dental Sleep Apnea Medical Billing https://niermanpm.com/blog/3-key-steps-for-dental-sleep-apnea-medical-billing https://niermanpm.com/blog/3-key-steps-for-dental-sleep-apnea-medical-billing#respond Wed, 28 Oct 2020 18:08:21 +0000 https://niermanpm.com/?p=14545 If a dentist treats obstructive sleep apnea using a custom oral appliance, then the treatment can be billed to the patient’s health insurance. But what are the steps you need in medical billing for dental sleep apnea appliances? In this latest blog, we will provide 3 key steps for dental sleep apnea medical billing success. […]

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If a dentist treats obstructive sleep apnea using a custom oral appliance, then the treatment can be billed to the patient’s health insurance. But what are the steps you need in medical billing for dental sleep apnea appliances? In this latest blog, we will provide 3 key steps for dental sleep apnea medical billing success.

1. Know The Medical Codes

medical billing codes, medical billing in dentistry

Most medical insurance plans provide coverage for custom oral appliances for Obstructive Sleep Apnea (OSA). While the medical codes are not the only thing you need for successful medical reimbursement, it’s surely important to have the correct ones! Not only to bill the medical claim but also to predetermine if the patients’ medical plan covers oral appliances for OSA.o

You will need two codes to bill or predetermine coverage for the oral appliance:

• ICD-10 Diagnosis Code G47.33: Obstructive sleep apnea (adult) (pediatric)

• HCPCS Code E0486: Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

Pro tip: most medical insurers require the modifier “NU” with HCPCS code E0486.

See the “Rose’s Rules” video blog on the medical codes for dental sleep apnea appliances.

2. Gather Data

soap notes,medical billing in dentistry

Prior to placing the oral appliance for OSA, copy the front and back sides of the medical card. Most practices then call the insurer to verify benefits.

Use the telephone number designated for eligibility/verification of benefits or predeterminations.

Gather key patient questionnaire information including their medical history, symptoms, treatment attempts, co-morbidities, and a copy of a diagnosed sleep study when available. *Diagnosis must come from a sleep physician.

Gathering this data builds your case of medical necessity, ensuring you have your ducks in a row, ready to respond to pertinent questions such as co-morbidities or other treatment attempts that the health insurance carrier may require in order to reimburse.

Pro tip: Use software to establish a repeatable system that allows your patients to complete their medical history & sleep screening questionnaire online.

3. Verify Benefits

Verifying benefits

Verifying medical benefits is always step #1!

Keep in mind, without verifying benefits, you can’t even be sure that the patient’s medical plan is currently active, let alone get an idea of what the patient’s out-of-pocket costs may look like, or if a pre-authorization is required. (super important to know!)

For dental practices, benefit verifications are typically accomplished with the medical plan by telephone.

You will find some medical insurers that allow providers to perform these online, however many times will require a phone call for a dental practice, as the information available online is not always as detailed as needed. When you verify benefits, be sure to record the remaining deductible, co-insurance percentage, out-of-pocket maximum remaining, and whether or not a pre-authorization is required.

Pro tip: For out-of-network providers: always verify both in and out-of-network benefits when available, you may be able to use the patient’s in-network benefits with an approved gap exception/network deficiency request!

Receive the Dental Sleep Medicine Patient Questionnaire

To download a free example of NPM Dental Sleep Medicine questionnaire fill out your information here:


We know that medical insurance reimbursement for dental sleep medicine has a significant impact on the patient’s decision to accept treatment.

Whether you are calling for benefits, doing a preauthorization or filing the medical claim for an oral appliance for OSA, there is a reason for every question the insurance representative asks. All of this information is needed before the medical insurance will agree to release any benefits the patient is due per their policy.

As stated above, most policies do reimburse for sleep apnea appliances. Your office can have incredible success with the right documentation and records and by learning the medical billing ropes.

That is why we, at Nierman Practice Management have the motto: “Get your ducks in a row” with dental to medical cross-coding solutions – including software systems, medical billing services, and above all, continuing education and training resources. Learn as much as you can about medical billing for dentists so that more patients can access life-altering oral appliance therapy for OSA.

Contact Us

Please feel free to contact us with any questions related to this article on getting started with medical billing for dental sleep appliance therapy, or the sample dental sleep apnea questionnaire. Send us an email at contactus@dentalwriter.com or call 1-800-879-6468 option 1.

About: Nierman Practice Management

Nierman Practice Management is the leader in medical billing and cross-coding solutions for dental practices.

They have been helping dental practices expand into medical billing, sleep apnea treatment, & TMJ/orofacial pain since 1988, with innovative technology platforms, training, and medical billing services.

Their solutions include:

DentalWriter Software – for SOAP Reports, Medical Billing, Sleep Apnea, TMD, & Implants

Nierman Medical Billing Service

CE Courses, Training, & Resources – Live, Online, and In-Office

See upcoming courses in medical billing for dentistry and happy cross-coding!

Article by: Rose Nierman

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What Do I Need to Bill Bone Grafts to Medical Insurance? https://niermanpm.com/blog/bill-bone-grafts-to-medical-insurance/ Tue, 27 Oct 2020 13:00:01 +0000 https://niermanpm.com/?p=13520 What do dental practices need to bill bone grafts to medical insurance? In her latest vlog, Rose Nierman explains the most important things a dental practice needs to have in place in order to successfully bill bone grafts to medical insurance. To learn more tips like how to bill bone grafts to medical check out […]

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What do dental practices need to bill bone grafts to medical insurance? In her latest vlog, Rose Nierman explains the most important things a dental practice needs to have in place in order to successfully bill bone grafts to medical insurance.

To learn more tips like how to bill bone grafts to medical check out more of Rose’s Rules, a video blog series from Nierman CE+. Nierman CE+ is an online learning platform for dental practices and dentists. The platform hosts the most comprehensive suite of online self-paced courses for medical billing in dentistry, including modules in sleep apnea, oral surgery, TMJ disorders, and more. Each course is hosted by cross-coding icon, Rose Nierman, who has over 32 years of experience educating dental practices in medical billing.

Nierman also hosts the course, Crosscoding- Unlocking the Code to Medical Billing in Dentistry. This course is available to attend in person, or to watch via livestream or on-demand. In this course, Rose takes attendees through all the ins-and-outs of dental-to-medical billing. Check out the upcoming courses on our schedule page here.

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What are the Medical Codes for Oral Sleep Apnea Appliances? https://niermanpm.com/blog/medical-codes-for-oral-sleep-apnea-appliances/ Tue, 20 Oct 2020 13:00:06 +0000 https://niermanpm.com/?p=13516 If a dentist treats sleep apnea using an oral appliance, then the treatment can be billed to medical, not dental. But what are the medical codes for oral appliances for snoring & sleep apnea appliances? In her latest Rose’s Rules vlog, Rose Nierman discusses the medical codes for oral appliances, and more. Want to learn […]

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If a dentist treats sleep apnea using an oral appliance, then the treatment can be billed to medical, not dental. But what are the medical codes for oral appliances for snoring & sleep apnea appliances? In her latest Rose’s Rules vlog, Rose Nierman discusses the medical codes for oral appliances, and more.

Want to learn more of Rose’s Rules? Check out Nierman CE+, and online learning platform for dentists and dental practices. On Nierman CE+ you can find more courses from Rose Nierman, discussing medical billing in dentistry for sleep apnea, TMJ disorders, Oral Surgery, and more.

Nierman also hosts many live and virtual seminars for medical billing in dentistry. Thousands of dental practices have attended her course, Unlocking the Code to Medical Billing in Dentistry. Through billing medical you can:

  • Increase monthly case acceptance
  • Create new revenue streams
  • Help more patients
  • Set your practice apart

To learn more about our upcoming courses in medical billing, sleep apnea, or TMJ disorders, check out our current dental CE schedule, which includes both live and virtual courses.

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15 Services for Dentists to Bill Medical Insurance https://niermanpm.com/blog/services-to-bill-to-medical-insurance https://niermanpm.com/blog/services-to-bill-to-medical-insurance#respond Tue, 20 Oct 2020 05:47:23 +0000 https://10.0.0.9/?p=6848 Is your dental office billing medical insurance? If not, you and your patients may be missing an opportunity for higher reimbursements through short-term medical insurance plans. Medical insurance often reimburses for procedures that dentists perform on a daily basis when the services are considered medically necessary. Some procedures should always be billed to medical insurance, […]

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Is your dental office billing medical insurance? If not, you and your patients may be missing an opportunity for higher reimbursements through short-term medical insurance plans.

Medical insurance often reimburses for procedures that dentists perform on a daily basis when the services are considered medically necessary.

Some procedures should always be billed to medical insurance, such as sleep apnea appliances and all visits related to Dental Sleep Medicine (DSM) such as exams and radiographs. According to many dental policies, the dental office must bill surgical procedures, first, to medical, before billing the dental insurance.

So we know that sleep apnea appliances and oral surgeries such as dental implants and jawbone grafts are often considered medically necessary. Services such as splints for Temporomandibular Joint (TMJ) Disorders with associated headaches and facial myalgia are another great example. And when it’s a condition that is considered by the medical plan, the x-rays and exams are typically paid, too.

Medical plans don’t impose time-related frequency limits on exams and radiographs because the need for them is based on the diagnosis or condition – not when the patient last receives these services. Reimbursement by medical insurance for bruxism (Botox!) and frenectomies for an infant with a tongue tie condition that interferes with the ability to eat is increasing for medical plans.

Although medical insurance reimburses more than ever before, policies do vary based on individual plans. The good news is that medical insurance plans do publish which services they pay (and exclusions in their “medical policies”.)

To ensure that you’re maximizing insurance coverage for your patients, we’ve listed 15 services for dentists to bill to medical insurance.

15 Dental Procedures Medical Insurance May Pay:

  1. Sleep apnea appliances (Dental Sleep Medicine)
  2. TMJ appliances and headache treatment
  3. Oral infections, cysts, oral inflammation
  4. Exams for services that are covered by medical insurance
  5. Panorex x-rays for services covered by medical insurance
  6. CBCT (cone beam) and tomography for services covered by medical insurance
  7. Frenectomy/tongue ties for infants and children
  8. Accidents to teeth
  9. Mucositis and stomatitis (from chemotherapy and other treatments).
  10. Facial pain treatment
  11. Dental implants and bone grafts
  12. 3rd molars or wisdom teeth extraction
  13. Biopsies
  14. Clearance exams before chemotherapy or surgery
  15. Botox Injections for bruxism and jaw pain

With all the opportunity there is to help patients who have medical-related symptoms, infection, obstructive sleep apnea, TMJ disorder, or oral surgeries, it’s essential for the dental office to have their ducks in a row to maximize medical insurance.

Getting Started

Ready to learn more? Receive instant access to our free Medical Billing in Dentistry 101 Training Webinar


More Training & Solutions

If you are looking for guidance on implementing dental-to-medical billing, Nierman Practice Management offers the leading implementation solutions, including software systems, medical billing services, and cross-coding and dental to medical billing seminars to help you achieve your cross-coding goals to help more patients and grow your practice.

Seminars such as CrossCoding: Unlocking the Code to Medical Billing in Dentistry, provide the education needed to bill medical insurance, and help your dental patients receive the services they need. This knowledge helps more patients with access to care for services that are life-changing! Assisting patients with maximizing reimbursement helps your practice stay on course with complete treatment plans the patient deserves. This course is available in-person, live-stream, or on-demand. See below for upcoming dates:

august, 2021

 

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Do Medical Policies Cover Dental Accidents? https://niermanpm.com/blog/medical-policies-dental-accidents/ Tue, 13 Oct 2020 13:00:20 +0000 https://niermanpm.com/?p=13512 We know we can bill medical for many services performed in the dental practice setting, but does medical insurance cover dental accidents? In the latest episode of Rose’s Rules, Rose Nierman reveals when & how dental accidents are covered by medical insurance. Rose Nierman has been educating dental practices in cross-coding and medical billing for […]

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We know we can bill medical for many services performed in the dental practice setting, but does medical insurance cover dental accidents? In the latest episode of Rose’s Rules, Rose Nierman reveals when & how dental accidents are covered by medical insurance.

Rose Nierman has been educating dental practices in cross-coding and medical billing for over 32 years. Her vlog series, Rose’s Rules, is part of Nierman CE+, an online learning platform for dental practices and dentists who perform medically necessary procedures in the dental practice setting. Nierman CE+ hosts the most comprehensive online suite of self-paced courses for medical billing in dentistry.

To learn more about medical billing and what covers dental accidents, check out Nierman CE courses. Rose Nierman also hosts many live and virtual courses in medical billing in dentistry. Her cross-coding courses have helped thousands of dental practices across the country get paid by medical for sleep apnea, TMJ disorders, oral surgeries, frenectomies, and more! Check out her upcoming live and interactive livestream courses by visiting the latest Nierman CE schedule.

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What is a Medically Necessary Service? https://niermanpm.com/blog/medically-necessary-service/ Thu, 08 Oct 2020 13:00:11 +0000 https://niermanpm.com/?p=13503 In the latest Rose’s Rules vlog, Rose Nierman breaks down the definition of “medical necessary service” and its relation to medical billing in dentistry. The vlog series, Rose’s Rules, is part of Nierman CE+. Nierman CE+ is an online learning platform for dentists and dental practices. It hosts The Complete Cross-Coder, the most comprehensive suite […]

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In the latest Rose’s Rules vlog, Rose Nierman breaks down the definition of “medical necessary service” and its relation to medical billing in dentistry.

The vlog series, Rose’s Rules, is part of Nierman CE+. Nierman CE+ is an online learning platform for dentists and dental practices. It hosts The Complete Cross-Coder, the most comprehensive suite of self-paced courses for medical billing in dentistry available online. Created by cross-coding icon, Rose Nierman, these courses take you through all the ins-and-outs of billing medical for sleep apnea, frenectomies, oral surgeries, TMJ disorders, and more.

Rose Nierman also hosts many live and livestreamed courses on dental-to-medical billing. Upcoming courses, live and virtual, can be found on the Nierman CE schedule.

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