As the practice of wellness becomes a more congruous and cohesive effort between practices, many medical and wellness practices begin to file insurance claims that might normally be filed with a specialist.

One such claim is that of sleep apnea oral appliance therapy (OAT) devices. When filing for a patient to receive treatment for sleep apnea, it is important to file the claim correctly in order to ensure claim approval.

Eligibility

Prior to filing an OAT claim, it is important to get in touch with the patient’s medical insurance in order to verify eligibility and benefits. Questions that need to be asked include:

• Is OAT covered by the plan?
• Will a preauthorization be required?
• What percentage will be paid?
• What is the deductible, how much of the deductible has been met, and when does the new plan year begin (to determine if a new deductible will apply)?
• What is the replacement time period?
• Is a referral necessary from the primary care provider?
• Do you require modifiers for the appliance?
• What is the claim mailing address?

These questions verify which services, procedures and medical devices the patient is eligible to receive through their insurance provider. Verifying eligibility allows for your clinic to grab a better sense of which services the patient can have billed to insurance, and which will most likely be paid out of pocket.

Documentation

Thorough SOAP note documentation is essential when filing a claim for sleep apnea. An example of SOAP notes for a sleep apnea case would be:

• A detailed report of exactly what the patient is struggling with. Be sure to include diagnosis codes within the note to ensure proper coding and approval from the clearinghouse.
• Examination findings including gender, height, weight, blood pressure and heart rate, etc.
• An assessment of the findings that determines the cause of the symptoms.
• A clear plan of treatment that includes the recommendation for an OAT device to treat sleep apnea.

The more detailed and clear the note is, the more likely the patient is to be approved for the OAT device for sleep apnea based on their current medical benefits. A lack of information or unclear SOAP notes does not provide an insurance company with enough valid information to approve a sleep apnea claim.

Sleep apnea claims that include proper billing and diagnoses codes, detailed SOAP notes, and verified eligibility allow for your practice to serve your patients needs more fully, and provide exceptional care.

For more information about the cross-coding capabilities of Apex EDI for sleep apnea claims, be sure to sign up for more information here.

http://www.dentaleconomics.com/articles/print/volume-103/issue-5/features/you-can-do-it-oral-sleep-apnea-therapy-coded-correctly.html

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.