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How to Code and File a Sleep Apnea Claim Correctly

As the practice of wellness becomes a more congruous and cohesive effort between practices, many medical and wellness practices begin to file insurance claims that might normally be filed with a specialist.

CPAP

One such claim is that of sleep apnea oral appliance therapy (OAT) devices. When filing for a patient to receive treatment for sleep apnea, it is important to file the claim correctly in order to ensure claim approval.

Eligibility

Prior to filing an OAT claim, it is important to get in touch with the patient’s medical insurance in order to verify eligibility and benefits. Questions that need to be asked include:

  • Is OAT covered by the plan?
  • Will a preauthorization be required?
  • What percentage will be paid?
  • What is the deductible, how much of the deductible has been met, and when does the new plan year begin (to determine if a new deductible will apply)?
  • What is the replacement time period?
  • Is a referral necessary from the primary care provider?
  • Do you require modifiers for the appliance?
  • What is the claim mailing address?

These questions verify which services, procedures and medical devices the patient is eligible to receive through their insurance provider. Verifying eligibility allows for your clinic to grab a better sense of which services the patient can have billed to insurance, and which will most likely be paid out of pocket.

Documentation

Thorough SOAP note documentation is essential when filing a claim for sleep apnea. An example of SOAP notes for a sleep apnea case would be:

  • A detailed report of exactly what the patient is struggling with. Be sure to include diagnosis codes within the note to ensure proper coding and approval from the clearinghouse.
  • Examination findings including gender, height, weight, blood pressure and heart rate, etc.
  • An assessment of the findings that determines the cause of the symptoms.
  • A clear plan of treatment that includes the recommendation for an OAT device to treat sleep apnea.

The more detailed and clear the note is, the more likely the patient is to be approved for the OAT device for sleep apnea based on their current medical benefits. A lack of information or unclear SOAP notes does not provide an insurance company with enough valid information to approve a sleep apnea claim.

Sleep apnea claims that include proper billing and diagnoses codes, detailed SOAP notes, and verified eligibility allow for your practice to serve your patients needs more fully, and provide exceptional care.

For more information about the cross coding capabilities of Apex EDI for sleep apnea claims, be sure to sign up for more information here.

http://www.dentaleconomics.com/articles/print/volume-103/issue-5/features/you-can-do-it-oral-sleep-apnea-therapy-coded-correctly.html

http://www.apexedi.com/sleep-apnea-tmj-claims/

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following 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: EDI, Resources

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Top Tips for Filing a Physical Therapy Claim

As a physical therapist, you have a lot on your plate. Filing claims shouldn’t take up the majority of your time and resources. We’ve compiled the top three tips for filing physical therapy claims to increase efficiency, profitability, and patient care.

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Optimize Claims

The first step is to optimize your claims. Be sure to use an up to date practice management software that allows you to keep track of each patient’s information, including their insurance information. Be sure that when you are writing the SOAP notes for each patient, that the billing and diagnoses codes are cohesive.

A great way to do this is with a clearinghouse. Medical billing clearinghouses scrub claims to ensure that each claim is correctly filled out before it can be submitted to a payer. If a claim is missing something, the clearinghouse will find it and notify the claims professional of the error. For more information on physical therapy claims billing clearinghouse services, click here.

Increase Efficiency

Increasing efficiency through a clearinghouse as discussed above is one way to start seeing more efficient workflows in your physical therapy practice. However, this is just the tip of the iceberg. Increasing efficiency can also be implemented through ensuring that your claims are optimized (as discussed above), so that inaccurate submissions can be avoided.

Also, it is important to assign roles among your billing staff. Who is responsible for filing claims? Who is responsible for following up on submitted claims? By assigning clearly articulated roles among your claims and billing staff within your practice, efficiency will be increased by minimizing redundancy of workplace tasks.

Digital Filing

Let’s face it, paper filing was great. But it had its day in the sun. The future is now, and the future is digital filing. Most insurance companies, Medicare included, will not accept paper claims. It’s simply not an efficient way to run an organization, and it costs businesses thousands of dollars each year to maintain a paper-only business.

If you’re not filing digitally, you’re going to run into a ton of road blocks. The first step is to ensure that you are using an efficient practice management software to keep track of your patient information. Next, you’ll want to get in touch with a claims clearinghouse in order to electronically transfer data to payers (insurance companies). If going digital seems too complicated, feel free to reach out to our friendly customer support staff here at Apex EDI. We can walk you through the process and demonstrate how user-friendly and efficient our services truly are.

For more information about filing physical therapy claims, and for efficient and integrative systems to use for your practice, be sure to contact us to discuss the best options for your business.

https://www.webpt.com/blog/post/ten-ways-physical-therapists-can-maximize-billing

http://www.apexedi.com/physical-therapy-claims/

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following 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: Chiropractic Claims, EDI

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The Do’s & Don’t’s of Filing Urology Claims

As a urology professional, you know the ins and outs of your practice. Here are a few helpful tips to ensure that your claims billing process maintains an even keel.

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Do Verify Patient Information

As with any claim submitted to insurance, verification of patient information is critical. Be sure to obtain the patient’s insurance information, verification of date of birth and Social Security number, as well as home address, and SOAP notes from the physician after the exam. Correct information for the patient will allow for urology claims to be approved within the patient’s coverage.

Do Verify Provider Information

It’s also important to verify your own information! When filing a urology claim, be sure to provide your practice’s correct address and contact information, as well as identification numbers and EDI processing numbers.

Do Scrub Claim With a Clearinghouse

Using a clearinghouse to verify the claim helps to increase efficiency and avoid errors within the claims process. An efficient clearinghouse will check your urology claims in order to ensure that each claim is error free before final submission. If an error is found, the clearinghouse notifies the billing professional. Fixing errors before final submission minimizes weeks of headache down the road for incorrectly filed or coded claims.

Don’t Resubmit Denied Claims

If a claim has been denied, it probably has been denied for a good reason. Before you automatically resubmit the denied claim, verify that the claim is error free. If the claim contains errors such as incorrect diagnosis codes, then it is possible that this is the reason for denial. Verify with the attending urologist which diagnosis codes should be assigned to the patient within the claim before proceeding with resubmission.

Don’t Double Bill for Visits

Some visits are not able to be submitted for claims twice under specific insurance coverage provisions. Specifically, Medicare has very clear regulations about billing for postoperative visits. Click here to read more about those regulations.

Don’t Forget the Clearinghouse

We really can’t say this enough. The purpose of a clearinghouse is to ensure that each urology claim is error free. A properly designed clearinghouse identifies errors, and notifies the claims professional of errors to be corrected before final submission.

Without the clearinghouse, it is possible and likely that claims will be submitted with errors. Error filled claims are likely to be denied based upon the errors within, causing your practice to resubmit the correct claims a second time. This submission and resubmission takes additional time and resources, causing a deficit in both time and money for your urology practice.

Follow these simple steps when filing a urology claim, and you’ll be sure to receive payment from payers in no time. For more information on clearinghouses for urology practice, visit this page.

https://www.auanet.org/resources/claims-submission-tips.cfm


Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following 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: Medical Claims, Resources

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What Information is Required for Filing a Dental Claim?

Even though diagnosis and billing codes may vary from patient to patient, a few items are required consistently on each dental claim. We’ll now discuss which items you’ll need to ensure are visible on each claim before submission of payment to the payer.

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What’s Required

The following information is required for filing a dental claim. Each claim that your practice submits to payers needs to include the following:

  1. The Subscriber’s ID;
  2. The Patient’s Name, Date of Birth and relationship to the Subscriber;
  3. The Dentist’s name or Practice Name, Tax Identification Number or Social Security Number, National Provider Identifier (NPI) and phone number;
  4. The American Dental Association procedure code number (CDT), treatment date, tooth number, tooth surface(s), doctor’s fees, and a narrative or description of services as appropriate;
  5. The Member’s signature for release of information and/or assignment of benefits. Signature on file is acceptable;
  6. The Dentist’s signature.

Ensuring Correct Submission

In order to ensure that each claim is correctly filed and submitted to the payer, it is advisable that your dental practice maintain an up to date practice management software. These softwares will allow your staff to enter the necessary data that is required for proper dental claims.

Be sure that the software you use for your dental practice is optimized to include the required data for each patient. For example, you might be able to create forms within your practice management software that allow you to created mandatory or required fields to be filled out before the form can be officially saved to the patient’s chart. Check with your software provider to see if these options are available to you.

In addition to practice management software, it is important that your practice utilize a clearinghouse. A clearinghouse is a software that integrates with your existing practice management software to scrub your dental claims for errors or inaccuracies. The clearinghouse notifies your claims staff of errors within the claims, allowing the claims professional to address and correct the errors before final submission.

If you would like more information regarding dental claim clearinghouse submission, check out our Dental Provider page to learn more.

https://www.benecare.com/dentists_info.asp?a=13&b=2

http://www.apexedi.com/dental-claims/


Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following 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, Medical Claims

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Tips to Submit Accurate Chiropractic Insurance Claims

As an increasing number of insurance companies are providing chiropractic benefits to their subscribers, chiropractors are submitting claims to insurance more regularly. Here are a few tips for submitting accurate chiropractic claims.

chiropractor

Date of Service

In many states it is required to include the initial date of service within a chiropractic claim. This initial date of service is intended to provide the very first visit of the patient to your practice, in which you, as the chiropractor, provided diagnosis and treatment for the patient requiring relief from subluxation through chiropractic care.

It is important to note that “date of onset” and “date of initial treatment” are not necessarily the same date. A patient may have acquired an injury several days or weeks before the actual chiropractic treatment had been initiated. Be sure to discuss the date of onset with your patient and make a record of it for claim submission.

Therapies Provided

Detailed documentation of the exact chiropractic therapy provided is essential to accurate chiropractic claims submission. For example, if a patient is requesting treatment for lower back pain, it is required that the exact vertebra that is in subluxation be recorded within the claim. Then articulate the adjustment completed to remedy the subluxation, and any additional therapies completed to ensure proper adjustment and setting of the vertebrae or extremity.

Keeping It Organized

In order to ensure that all of your claims are properly filed and submitted, it’s important to maintain an up to date practice management software and the records that correspond with that software. In addition to the practice management software, it’s important to incorporate a clearinghouse that integrates with chiropractic claims.

One such clearinghouse is Apex EDI. Apex integrates with dozens of practice management softwares to ensure proper scrubbing of chiropractic claims. For more information about how Apex EDI can help your chiropractic practice maintain accurate claims submission, be sure to check out our Chiropractic Claims page or contact us today.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following 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: Chiropractic Claims, EDI

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