Dental Sleep Medical Billing Malice
Medical billing has “make or break” consequences for dental sleep practices. Regardless of how much knowledge you have about the pathophysiology of the apneic’s airway or the depth of your appliance armamentarium, if you’re not able to make money, your practice isn’t going to be around long. Your patients will go to a provider that utilizes their insurance benefits, and you’ll get frustrated and bail on DSM altogether. This isn’t conjecture. I’ve seen it happen hundreds, possibly thousands of times.
There are some really capable medical billing companies out there; some more than others. However, they all must contend with the machinations these medical payors use to avoid paying for claims. The pristine medical billing companies are well-versed in these issues, stay on top of them, and serve as sherpas to help you avoid these obstacles. They also communicate effectively and efficiently with practices to keep them apprised of claims status and unforeseen issues. That’s what really separates stellar medical billing companies from the rest. Caveat emptor.
They want to help you. Let them.
However, you and your team can also take active steps to drive the medical billing processes in the right direction. If you knew the shoddy documentation some of your DSM colleagues submit expecting reimbursement, you’d probably laugh. When the claims aren’t paid, or the billing company pushes back requesting proper documentation, you’d be ashamed by some of your DSM colleagues’ responses.
“I should sue you. How’re you even in business, yousonsofbitches!?”
“Yeah, I changed the sleep study date, so what, I used to do it all the time with my old billing company!”
“We got paid on the last 5 claims from that insurance and we didn’t need that document. Now you’re telling me we do. This is BS. I’m telling everyone on Facebook how sh*tty your company is.”
By the way, I have ZERO involvement with any medical billing companies, but I used to many moons ago. Some of the claims that would come through screamed “RECOUP ME” and some of the cussing complaints that would result from our refusal would make you blush.
Most of these medical billing companies are compensated based on a percentage of what the claims ultimately pay. It is incumbent upon them to maximize reimbursement for your practice. The more you get paid, the more they get paid. It’s simple. Their requests for additional documentation and refusal to submit incomplete claims, or updating you of the insurance companies’ new hoop to jump through isn’t a personal affront. They want to help you. Take some advice from Mel Robbins and “Let them.”
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