Managing Medical Reimbursement in the Dental Office-Managing Medical Reimbursement In The Dental Office Video

Video Transcription
Video Summary
In this video, the speaker emphasizes the importance of staff involvement and knowledge in dental sleep medicine. The speaker mentions that staff members need to be the cheerleaders to get the ball rolling and that there is a lot to learn in this field. Patients typically have questions about costs, insurance coverage, and out-of-pocket expenses, so it is essential for staff members to be informed. The speaker also discusses the differences between medical and dental insurance, stating that physicians are more concerned about costs and want to know if the practice accepts insurance and is a Medicare provider. The speaker advises knowing the geographic area and understanding insurance participation, Medicare coverage, and in-network status. The video provides guidance on insurance handling, stating that each medical insurance company has a medical policy with guidelines for oral device coverage, and this information is available online. Staff members should obtain patient demographic information, tax ID number, NPI number, diagnosis code, insurance card, deductible amount, copayment, and maximum out-of-pocket. The speaker recommends asking insurance companies if authorization is required and keeping a record of all calls with reference numbers. The process of obtaining insurance coverage involves determining if the item is coverable, knowing the diagnosis and procedure codes, and preparing to submit predeterminations or authorizations. The speaker provides a checklist of documents to include when submitting an authorization, such as the insurance claim form, sleep study results, referral or prescription form, and letter of medical necessity. The importance of correct claims address and authorization forms is highlighted, along with an explanation of the gap exception. Medicare coverage and billing is also discussed, mentioning the need for certain documentation and use of modifiers. The video emphasizes the importance of follow-up in the insurance process, suggesting a system to check for receipt and progress of authorizations and claims. The speaker also mentions the need to follow up on patient payments and advises developing a follow-up plan tailored to the dental sleep medicine process. Finally, the speaker encourages embracing the opportunity to change people's lives in dental sleep medicine for the right reasons and treating patients with care. The video concludes with suggestions for implementing a checklist and organizing patient information, as well as a mention of the importance of documentation. No credits are mentioned in the video.
Keywords
staff involvement
dental sleep medicine
insurance coverage
authorization
follow-up plan