Medicare Q&A June 2025-Medicare Q&A Recording

Video Transcription

Video Summary

The discussion focused on updates and common issues related to Medicare policy concerning oral appliances for obstructive sleep apnea. Advising there have been no new updates or reconsideration requests to the Local Coverage Determination (LCD) since 2021, experts indicated no changes to Medicare's policy currently. Key challenges in billing and coding include checking beneficiary eligibility, avoiding inpatient stay billing, and ensuring all necessary modifiers (KX, GA, GY, GZ) are attached to submissions to avoid claim rejections.<br /><br />Regarding audits, no specific oral appliance audits are happening, suggesting compliance is being maintained well. In billing matters, it's crucial to include all documentation and modifiers as advised, and if claims are denied, utilizing the appeals process with all supporting documents is essential. Sleep studies don’t expire for DME MAC purposes, allowing use of older studies if they meet current guidelines, although practitioners may opt for newer ones based on medical necessity. <br /><br />Overall, the emphasis was on maintaining accurate and thorough documentation, staying updated with policy norms, and understanding coding and audit preparedness to ensure smooth operations within dental and medical billing under Medicare contexts.

Keywords

Medicare policy

oral appliances

obstructive sleep apnea

Local Coverage Determination

billing and coding

modifiers

claim rejections

audit compliance

documentation