Sleep Apnea Dentistry is perhaps the fastest growing part of my life. In my career I have always associated with the best dentists in the country. In my travels I have heard one question over and over again “Is a dedicated sleep practice right for me?”. The other question is “How will I know when to make the jump to a sleep only practice?”. This is the second installment of a 5 part series.

I asked Dr. Willey to write up his journey in sleep medicine, from the early days of training with Dental Sleep Medicine Pioneer and Legend Dr. Ed Spiegel. Being the person Dr. Willey is, days later I received a call from him, he said ” David I want to tell a five part history from the being leading up to my lecture in Scottsdale” from the very beginning. He told me he could do it in a five part series on his personal journey, here is part one. Remember at the American Sleep and Breathing Academy Dental meeting in Scottsdale AZ April 10-11 www.asbadental.com he is going to explain how he built the largest dental sleep practice in the United States, 2.5 million a year and 106 appliances in a single month.

IS A DEDICATED SLEEP PRACTICE RIGHT FOR YOU?

Part 2 – ‘Building an Alliance’

 

I finally had an opportunity to meet him. Recognizing the connection between my practice of obstructive sleep apnea and his practice of Ears, Nose and Throat, Dr. Holland was someone with whom I wanted to build an alliance.  Our office had made numerous calls in an attempt to set up a meeting and finally, we were in! Our conversation went well, both of us realizing that our philosophy for treating patients were symbiotic. As I left his office, I couldn’t help but think, “The real test will be IF he refers any of his patients to me.” As the months went by, he sent many referrals to me and soon became one of my largest referral sources and continues to this day.

The reason for his referrals had little to do with my reputation, location or credentials. It had everything to do with his perception that I was a sleep specialist (though I could never claim this title) because I

limited my practice to OSA and TMD.  And, because I was practicing in a medical model just like he was. The medical model was key, meaning that I accept most all medical insurance and Medicare.

Many dentists are interested in providing sleep and/or TMD appliances to their patients, but the amount of work to get payment for these services seems overwhelming, even with software specifically designed for dental sleep medicine.

Jumping into the medical world can seem easy at first glace. It’s just a different claim form, right? Wrong. Most doctors aren’t aware of the risks of not asking the right questions on the pre-verification phone call and having all the necessary documentation on file. For instance, a dentist can bill a claim for the E0486 (OSA appliance) to Medicare and may see an immediate payment without records ever being requested. The issues come when Medicare decides to do an audit, which is guaranteed to happen.  If all documentation is not in complete order prior to impressions being taken, Medicare will ask for the money back and require it in a lump sum.   There could also be fines for non-compliance as a Medicare provider.  As you are well aware, this can completely bankrupt a practice.

I personally experienced a Medicare set back when I first began.  Our office staff had been trained that the x-ray we were taking on all our patients would be covered by Medicare.  When we started receiving denials for these x-rays, and realized that Medicare would not pay due to our provider type, we had to write off all charges.  As a Mediare provider, it is our responsibility to know what will be covered and what is not a covered procedure.  Fortunately our practice was in the beginning stage and it was early enough that my set back was minimal and I was able to appreciate a hard lesson well learned.

Medicare requires that all participating physicians convert to Electronic Health Records by 2015. A monetary penalty will be assessed if not fully in compliance. Certified software specific to dental sleep medicine is a must. In order to bill an evaluation and management procedure code, certain criteria must be met. Each visit must be evaluated prior to coding. This is important to prevent a Medicare trigger resulting in an audit. I found that audits are not only time consuming but drastically slows down payment flow.

Calling an insurance company for a pre-verification of benefits shouldn’t take a scientist.  Unfortunately, depending on the question, the representative interpreting the information, and the way the question is asked, wrong information can be given resulting in unhappy patients and a loss of money for the provider. Even if a code is “billable,” it may end up being denied.  I am thankful to have a dedicated billing department who understands the pre-verification process and the requirements necessary for maximum insurance reimbursement.

Being a Medicare provider carries much responsibility. When auditing records, Medicare can look into ANY patient, not just Medicare patients. What you do for one, you must do for all. Guidelines on insurance fraud, professional courtesy, and write offs are closely monitored. Medicare, Medicaid, and Tricare are all government agencies and any penalties or charges are a federal matter.

Another factor in building an alliance with specialist in the medical world is providing them with a sample of the appliance you are providing for patients.  I found that if I hand them an actual appliance they will recognize the difference between what we offer and what the local Walgreens and CVS stores offer over the counter.  When I provide them with a Gergen’s Lab appliance, it is impressive and professionally packaged.  Month after month I have the privilege of seeing 35-50 OSA/TMD patients every day, it is imperative that I can depend on my lab to ensure my reputation with my alliances is secure.

 

David Gergen CDT opened his family-owned Gergen’s Orthodontic Lab in Phoenix, AZ in 1986 and now employees over 80 people. David Gergen has been a nationally respected dental lab technician for over 25 years. He received the award for “The Finest Orthodontic Technician in the Country” given by Columbus Dental in 1986. He also received a lifetime achievement award by Dr Harold Gelb Academy as Americas greatest Orthodontic technician of all time, in 2012. He has worked for some of the pioneers in the orthodontic and sleep dentistry fields. Gergen and his father John Gergen began Gergen Orthodontic labs in 1984 and have grown it into one of the most respected labs in the country. One of his proudest achievements is receiving The National Leadership award for Arizona Small Businessman of the Year in 2004. David is the Dental Director of the American Sleep and Breathing Academy and he has also taken a spot at Tufts University teaching seminars for the Continuing-Ed program on Dental Sleep Medicine.