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A Typical Visit: What Your Endodontistry Claim Will Pay For

Endodontists specialize in performing root canals and other procedures in order to save teeth. Endodontic treatment helps the patient maintain a natural smile, continue to eat foods that he or she loves and limits the need for ongoing dental work.

teeth

A typical visit begins with the patient completing a medical history, including all current prescription medications and medical consent forms. Then a series of x-rays will be completed and the endodontist test the tooth in question along with adjacent teeth. After the tests are complete, the endodontist will discuss treatment options with the patient.

The Endodontist will advise the patient of the proposed treatment options and any reasonable alternatives, so the patient can make a fully informed decision. The treatment procedure may start immediately by giving the patient a local anesthesia to numb the area to be treated. If the procedure can’t be performed in one visit, medications may be used in the tooth in between visits.

spooky teeth

A dentist or endodontist may periodically x-ray the tooth to ensure that healing has occurred. At times, the tooth may become painful or diseased months or even years after successful treatment. When this occurs, often repeating the endodontic procedure can save the tooth.

Submitted claims usually pay for an initial office visit, x-rays, testing, local anesthesia, medication and treatments recommended such as a root canal and post-treatment crowns. After the tooth has been restored, it’s important to practice good oral hygiene, including brushing, flossing, regular checkups and dental cleanings so that you do not have to go back and have and pay for an additional visit. With proper care, most teeth with treatment can last as long as other natural teeth and often for a lifetime.

We at Apex EDI are more than happy to help and answer any questions you have about claims. Contact us today!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

 

Posted in: Dental Claims, Endodontristy Claims

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A Typical Visit: What Your Audiology Claim Will Pay For

Audiologists are highly trained professionals who specialize in evaluating, diagnosing, treating, and managing issues related to hearing, tinnitus, and balance disorders. They use a variety of tests and procedures to fully evaluate the hearing ability and/or any balance issues of the patient. Some audiologists may also fit and dispense hearing aids or other hearing devices.  Audiologists perform three main types of tests which are all covered by audiology claims.

Ear

1. Otoscopy

The audiologist looks in the ear canal with an ‘otoscope’ and magnifying pen light. Blockages such as ear wax or problems within the ear canal or eardrum are diagnosed.

2. Tympanometry

The audiologist tests the middle ear function by testing to see how well the eardrum responds to light pressure. The test detects disruptions that inhibit motion of the eardrum like fluid, infection, or eustachian tube dysfunction.

3. Audiometry

The audiologist performs this test by placing the patient in a soundproof booth or room and then asking the patient to raise his or her hand (or push a button) when he or she hears a sound. This test determines air conduction, the softest sound you can hear through earphones at several different pitches, and bone conduction, the softest sound you can hear by stimulating the inner ear directly.

Nurse_with_patient

Afterwards, the test results and recommendations will be explained to the patient. An Audiologist may refer the patient to an ENT doctor specializing in ear, nose and throat or a hearing aid specialist depending on the test results and further medical care required.  

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

 

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Optometry vs. Ophthalmology

Trusting a doctor with eye care is an important health care decision. The type of eye doctor a patient uses is largely a matter of personal preference if the eyes are healthy and don’t require specialized medical or surgical treatment. There are two types of eye doctors: optometrists and ophthalmologists. Both perform routine eye exams and are trained to detect, diagnose and manage eye diseases that require medical and non-medical treatment. Apex EDI handles both Optometry and Ophthalmology claims.

an eye

An optometrist is an eye doctor who has earned the Doctor of Optometry (OD) degree. Optometrists examine eyes for both vision and health problems, and correct refractive errors by prescribing eyeglasses and contact lenses. Optometrists in the United States are also licensed to prescribe medications to treat certain eye problems and diseases. The scope of medical care that can be provided by optometrists is determined by state law.

eyechart

An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO) who specializes in eye and vision care. Ophthalmologists are trained to perform eye exams, diagnose and treat disease, prescribe medications and perform eye surgery. They also write prescriptions for eyeglasses and contact lenses. It is important to seek care from an eye doctor highly trained if you already have a medical eye problem such as glaucoma, macular degeneration or cataracts. In many cases, this means that medical or surgical eye care by a specially trained ophthalmologist is in order.

Another factor in the patient’s selection of an eye doctor is determining if he or she is an authorized provider under the vision or medical insurance plan. Most optometrists and ophthalmologists accept Medicare for older patients. However, while Medicare covers your visits to an eye doctor for medically necessary eye care, it does not cover routine eye exams. Prior to the submission of a claim, it’s helpful to verify coverage and out-of-pocket expenses for the exam.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

 

Posted in: Opthamology Claims, Optometry Claims

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Acupuncture Claims


Acupuncture is a safe ancient form of Chinese medicine received by millions annually.  According to the National Institutes of Health reports that acupuncture is one of the most common forms of alternative medicine covered by insurance.

120216-N-PB383-414 ARABIAN GULF (Feb. 16, 2012) Cmdr. Yevsey Goldberg conducts an acupuncture procedure on a patient aboard the amphibious transport dock ship USS New Orleans (LPD 18). New Orleans and embarked Marines assigned to the 11th Marine Expeditionary Unit (11th MEU) are deployed as part of the Makin Island Amphibious Ready Group, supporting maritime security operations and theater security cooperation efforts in the U.S. 5th Fleet area of responsibility. (U.S. Navy photo by Mass Communication Specialist 2nd Class Dominique Pineiro/Released)

During the first session, a practitioner inquires about the patient’s health and medical history, and examines the pulse and tongue. Practitioners ask about the medical ailments the patient hopes to treat and medications currently taken. Fees for an initial medical consultation and an acupuncture session where thin, sterile needles are inserted into pressure points in the skin, should be paid for with a medical claim.

During this session the practitioner also determines the appropriate number and duration of follow-up visits to treat the medical condition. Costs are similar nationwide and don’t vary greatly between clinics and private practitioners. Fees for an initial visit range from $75 to $95. Routine visits cost $50 to $70.  

Many practitioners recommend patients take specialized Chinese herbs, such as ginseng and gui pi wan, that are designed to supplement the acupuncture. These types of supplements may not be covered under medical claims.

Acupuncture_Needles

While clinic practices vary, some practitioners also accept gratuities of 15 to 20 percent of the bill. Gratuities are generally not paid and not considered compulsory. For a claim to be fully paid, there must be an appropriate diagnosis to establish the medical necessity of the procedure.

Coverage for any claim should be verified before treatment from a clinic or private practitioner. Verifying coverage and communicating clearly with the patient regarding essential and optional services can minimize concerns and ensure claims are processed timely. Contact us today at Apex EDI and we can help you with your claims today!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

 

Posted in: Acupuncture, Acupuncture Claims, Apex EDI, Resources

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Ophthalmology Claims

As an ophthalmology professional, you must ensure all claims are submitted properly to ensure your business continues to run smoothly. Here are a few general tips to make sure claims are both accurate and timely.

an eye

First, as with any claim, be sure to obtain and verify all of the necessary patient and provider information. Accurate information allows claims to be processed and paid without delay. It’s also important to submit claims promptly with all supporting documentation. Check the claim prior to the final submission to be sure that it is error free. This will help minimize stress that can be caused by claims that are coded or filed incorrectly. Common errors such as failing to submit a quantity of 2 to obtain payment for both eyes, or not indicating the correct modifier for the procedure performed can lead to weeks of delay.

Vision plans cover routine wellness exams for eye health. Medical eye care, on the other hand, is for the treatment of specific medical conditions related to the eye, such as pink eye, cataracts, or double vision. The diagnosis and treatment for these conditions should be billed through the medical eye care insurance. You’ll want to ensure that you are billing the correct insurance to receive payment promptly.

Following these simple steps when filing an ophthalmology claim, will increase the efficiency in your office and ensure you receive payment from payers in no time. Apex EDI can help ensure the best possible care for your patients by verifying vision and medical claims before they are sent to the payer for final submission. Apex EDI works to get you paid faster.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Opthamology Claims

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