Watch Dr. Erin Elliott's "sawing logs" video here.
I practice general dentistry in the Northern Idaho Panhandle. And it is gorgeous! We have the beauty of lakes, mountains, rivers, and trees—lots and lots of trees. Plus, there is not a potato farm in sight. To preserve this beauty, my practice went paperless in 2004. One day we were using paper charts and old-fashioned x-rays, and the next day we were doing all of our notes and radiographs in the computer. So why does it feel like we still use so much paper? Part of the reason is that we do medical billing for sleep apnea treatment, and the medical world revolves around paper. In this article, we are going to discuss the paperwork needed in order to bill an oral appliance. Dust off those fax machines!
My sleep patients come to me in many different ways. The first is through our regular hygiene appointments. Are you screening for potential sleep apnea within your existing patient pool? Are you looking at medical histories? Are you changing your medical history script to ask patients about sleep and snoring? We are constantly looking for patients who take high blood pressure medications, or who have acid reflux, heart conditions, diabetes, bruxing, large tongues, vaulted palates, and so on. If they show these symptoms (there are many more) we begin a conversation and get them scheduled for a consult. My sleep patients also come from outside my four walls. Word of mouth, print ads, and social media have helped boost my consult visits. But my favorite type of sleep patients are those referred by health-care providers in my community. I love hearing my fax machine whirring in the morning. Yes, I said fax machine, not e-mail. We have a person assigned to calling the referrals, scheduling the patients, collecting the sleep studies, and sending off the paperwork.
Before the consult appointment is even scheduled, the front desk person fills out an intake form, so even if we have someone new working that day (there seems to be a revolving door here), it looks like we know what we are doing. The intake form asks all of the necessary questions to get medical information, sleep study results, and contact information. Then, we e-mail the patient the paperwork we have from our software specifically made for dental sleep medicine. If someone has an aversion to technology, we can mail them the paperwork or they can come in early to their appointment.
When the patient decides to move forward with treatment, we have a few forms that need to be signed. Although we have already had a discussion regarding informed consent, we have the patient sign an informed consent agreement. You can make the agreement as simple or as complicated as you want. The American Academy of Dental Sleep Medicine can provide you with a good one. Patients fill out an Epworth Sleepiness Scale at their initial appointment so that we can prove they are experiencing excessive daytime sleepiness to insurance. We also have patients sign a financial arrangement form. There is a lot of information in this, as we want patients to know we are filing medical insurance on their behalf as a favor. In addition, it touches on the fact that there is no money-back guarantee, and if the insurance mails a patient the check, he or she needs to turn it over to us. Patients also fill out a CPAP intolerance form, whether they have tried CPAP or not. If a patient has never tried CPAP, then we still have him or her fill out the form, stating that oral appliance therapy is being used as first-line therapy in mild to moderate cases. And lastly, we have patients fill out a proof of delivery form. Because Medicare requires this, we do it for every carrier. Phew . . . tired yet? That’s a lot of paper and a lot of trees.
At follow-up appointments, we have patients fill out follow-up questions about snoring, energy level, and sleep quality. We also have them fill out an Epworth Sleepiness Scale, which allows us to objectively measure their progress on fatigue.
The final piece of paperwork is letters to patients’ physicians sent throughout treatment. In fact, this is the best marketing I do. In order to send these, I must do SOAP notes, which medical insurance requires as well. Let me explain. SOAP is an acronym for Subjective, Objective, Assessment, and Plan/Procedure. Subjective notes include how the patient is feeling (i.e., the chief complaint). I usually put these in quotation marks, so it is in the patient’s own words. I include history, symptoms, other therapies attempted, family history, social history, etc. The objective portion includes measurements or what I observe (i.e., my findings). I include blood pressure, pulse, weight, height, BMI, sleep testing numbers, and Epworth Sleepiness Scale score. A is for assessment. This is where the differential diagnosis, diagnosis, and the patient’s overall progress are recorded. Finally, I include the plan or procedure done. It is best if you can get your whole team on board and even do SOAP notes in your dental software for dental procedures.
There you have it. It may seem like a lot, but it is all doable. My biggest call to you is to get trained and get trained now. Stop making snore guards and start saving lives. If you are medical billing for patients, then more patients will move forward with treatment. The more patients that are being treated, the more trees that will be cut down. But don’t worry. We have a strong timber industry here in Idaho.
Forms mentioned in this article:
- Patient intake form
- Informed consent agreement
- CPAP intolerance form
- Proof of delivery form
- Financial arrangement
- Snoring, energy level, and sleep quality follow-up questions
- Epworth Sleepiness Scale
- Letter to the patient’s physician
Erin Elliott, DDS, is a practicing general dentist in Post Falls, Idaho, where she has successfully integrated dental sleep medicine into her busy general practice. She lectures extensively and leads a hands-on workshop focusing on practical strategies for successful implementation of sleep medicine into the general practice. She is an active member of the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine. She is a past president and diplomate of the American Sleep and Breathing Academy. Contact her directly at [email protected].