Accurately Document Procedure Codes for Proper Reimbursement

 

Today's Guest Susan Rohde, RHIT, CCS-P, CPC Senior Manager Eide Bailly's Healthcare Division srohde@eidebailly.com

 

The Transcript

Art Wiederman, CPA: Hello everyone and welcome to another edition of the Art of Dental Finance and Management with Art Wiederman, CPA. I'm Art Wiederman. I am a dental specific CPA and a dental division director for the CPA firm of Eide Bailly, and I'm located out here in beautiful Southern California. So welcome to my podcast and we're here recording in early February of Twenty Twenty Two.

And today we have a very important topic that we're going to talk to you about. And most dental offices, many dental offices have to deal with dental insurance. Assignment of benefits. Many of you actually help the patients and file the insurance claims and you are putting down that, OK well, today we did an 1110 and we did a 2950 and all these things.

Well. One of the wonderful things about being part of Eide Bailly is we. I just seem to have experts in everything, and I have an expert in dental coding here. Susan Rohde is a senior manager in our Fargo, North Dakota office, and Susan works with a lot of dental practices on how the coding works and what mistakes we make, and we're going to talk a lot about what's new for 2022. There's a lot of new stuff going on in different areas of dental coding, so we'll get to Susan in a moment.

So first, let me let me tell you about our wonderful partner, Decisions in Dentistry magazine. Lorraine Kent and her wonderful team puts out the best dental clinical magazine on the planet as far as I'm concerned. They have over 140 continuing education courses at a very reasonable price, so go to their website www.DecisionsinDentistry.com.

We are a proud member of the Academy of Dental CPAs, 24 CPA firms that represent over 10,000 dentists. We at Eide Bailly represent over a thousand dentists in our dental practice, so you can get a hold of all of us. You can go to our website www.ADCPA.org. We are there and we're very excited. We're having our first meeting in two and a half years up in Northern California. We haven't met because of the pandemic.

One announcement I wanted to make, and I'll keep making this until July. I am going to be a featured speaker at the National Academy of General Dentistry meeting in Orlando, Florida. And the dates of that meeting, I believe, are July 27 through July 30th. I do not know which date I am speaking. I'm going to be doing an all day program on the financial planning and other dental financial aspects and issues. So if you are coming to the meeting, please come by my lecture. Tell me that you're a podcast listener and I'd love to meet you and say hi and you'll get to see me in the flesh. I might tell some of the same stories at the lecture that I tell on the podcast, but I am honored and humbled at the thousands of people that listen to my podcast each month that we publish.

So again, I will be in Orlando, and I found out from one of my good friends that Bay Hill, where they play the Arnold Palmer Open, is right next door. So I might have to include some golf in that too. But it just seems like I include golf in everything.

So a couple of other things I want to remind you of. Now we are going to be publishing this podcast in late March. So if you hear this before March 31st and you have not filed onto the portal for the HHS Provider Relief Fund, if you got more than $10,000 from the HHS Provider Relief Fund, you need between July one, 2020 and December 31 of 2020, you need to file on the HHS, or it's actually called HRSA's portal. And if you don't and you got this money and you don't report it, you are going to have to give the money back plain and simple. Please make sure you do this.

We at Eide Bailly did a really, really, I think, great two plus hour webinar on how to navigate this portal on January 21st. If you want to acquire a copy of that recording again, send me an email at awiederman@eidebailly.com and that is available for purchase, it's a very nominal fee that we charge for that, for that webinar, and it has helped I know hundreds of dentists navigate this, this portal, but you really need to make sure you do this. If you're listening to this after March 31 and you haven't done it, all I can tell you is you've got to hope that the government gives you some sort of an extension. They are not planning on doing that at this time.

Finally, if you had a greater than 20 percent reduction in your gross revenues, either in the first, second and third quarter of 2021 versus that same quarter in 2019, any of those quarters a 20 percent or greater reduction in your collections, net of patient refunds or if you had that same 20 percent reduction in the fourth quarter of 2020 as compared to the fourth quarter of 2019, we can use to look back rules. You are going to be eligible for the 2021 ERTC. We are getting stupid amounts of money that is a California term, stupid amounts of money for dentists.

I've done, I think the last three I did were 85,000, ninety two thousand and two hundred and forty thousand dollars. That's tax credit. That's money in your pocket legally from the employee retention tax credit program. Again, give me a call six five seven two seven nine three two four three. If you think you might be eligible, we do a complimentary analysis of whether you are and if you are, we'll let you know what it looks like and see if you want to go forward.

So with that said, let's go ahead and move into speaking with my guest, Susan Rohde. Susan, as I mentioned, is a senior manager with Eide Bailly in out of Fargo, North Dakota. She's been with the firm for over 20 years and specializes in coding for health care professionals. Worked a lot of dentists, other health care professionals. And again, we're going to talk about a lot of really good stuff regarding coding. I mean, coding is a probably a five consecutive day podcast. If you want to do that, so we won't be doing that today. But Susan Rohde, welcome to the Art of Dental Finance and Management.

Susan Rohde: Thank you, Art. I'm happy to be here.

Art Wiederman, CPA: Well, I'm glad you're here now. I understand that you're a big you and your family are big hockey fans and you have a particular team you like, right? Tell me about the hockey in your family.

Susan Rohde: Oh, we are. I have four kids. They all play hockey and we live in Minnesota. I live in a very small town outside of Fargo, in Minnesota. We like the Wild, but we are major Chicago Blackhawks fans.

Art Wiederman, CPA: Okay, so I have to tell my story about hockey and Blackhawks. So I grew up in Brooklyn and Brooklyn, New York, and I was a New York Rangers fan. So my mom, I talked about my mom on the podcast. Occasionally my mom, Cynthia. She joined me up to be a member of the New York Rangers, the New York Rangers fan club. And I, I would go, we'd get on the subway to go to 34th Street and where Madison Square Garden was, and I would go to the meeting and being the future accountant that I was when I was eight or nine years old, I asked the head coach, Emil Francis, in front of about 200 people. Coach Francis, what was the average number of goals that the Rangers scored last year? And it's like, I'm going to become an accountant. I'm asking about numbers. I'm not asking about any of the players or what hockey is. I'm asking average numbers, right?

But my favorite story, Susan, was my dad. My stepdad actually was a photographer for United Press International. And in fact, he was one of the original people that took the photograph in the 50s of Marilyn Monroe on a subway platform. But with the wind blowing up her skirt, it's a famous, famous picture. Yeah, yeah, he was one of about seven or eight people and he did that, but he used to take me to the hockey games. He and I were big hockey fans. And so he, because of his affiliation with United Press, he got really good seats.

So we were sitting right behind the glass at Madison Square Garden. And this was the old Madison Square Garden. Because the new Madison Square Garden got built in 1969, Frank Sinatra was the first person to ever perform there. And so I was at a game between the Rangers and the Chicago Blackhawks. Your favorite team, right? And you might remember some hockey player he might be in the Hall of Fame, but Bobby Hall, I think his name was.

Susan Rohde: Absolutely.

Art Wiederman, CPA: OK, so we're watching the game and one of the Rangers players, I will keep names out of this kept fouling him and slashing and the, you know, the referees never saw it. And when you're down there really close to the glass, you can hear them talking. So I heard Bobby Hull say to this player, if you do that one more time, you're going over the glass. Now at that time the glass was low. Well, he did it. He basically fouled him one more time. Now Bobby Hull, as you know, Susan, was probably known as the fastest skater in hockey, right? Yeah. OK, so Bobby Hull skated to the other end of the Madison Square Garden rink and basically took off like it was a speed skating. Put his shoulder down and put this hockey player into about the seventh row went right over our heads. It was hysterical. I mean, yes, it has nothing to do with dental coding, but it's a great story. I was a big fan.

Susan Rohde: That is a great story. My kids would be very jealous.

Art Wiederman, CPA: They would be OK. Well, anyway, Susan, tell me a little bit about your story, your history. You know where you came from and what you do?

Susan Rohde: Absolutely. Again, as Art said, My name is Susan Rohde. I am a senior manager in the health care division of Eide Bailly. I have been here a little bit over 20 years, but not quite 21, which is super strange because I'm only twenty nine, so I just kidding. Before that, I had one other job working at a large PPS hospital, so basically my entire career has been at Eide Bailly. I specialize in professional coding, which means coding for the provider as opposed to coding for the facility. I've worked with all different specialties throughout my career, including the dental profession, which is its own beast, as opposed to some of the other more traditional specialties like family practice or internal medicine. Dental definitely has its own niche as they have their own codes. They have their own code set. And I was thrilled when Art asked me to come on his podcast.

Art Wiederman, CPA: Well, thank you, Susan, for that. So let's start with a 35,000 foot view. I mean, talk about the system, the coding system. I mean, most of our dentists know this, but maybe we have some new not maybe I know we have some new doctors coming on, maybe new practice owners. I mean, talk about how the CDT code system works and what they should be using, and then we'll get into some specifics.

Susan Rohde: Absolutely. So if we were on the medical side, those providers have codes called CPT or current procedural terminology codes, and that's how they assign their procedures and their five digit numerical codes. On the dental side, we have what's known as Current Dental Terminology or the CD as in dog T, and those are managed and maintained by the American Dental Association, where the CPT codes are managed and put out by the American Medical Association. So that all makes sense. And that CDT, they contain all the dental codes that are required for every dental procedure. And if there is an oddball dental procedure that will have an unspecified code. But these are the codes that you would submit to your dental insurance plan.

Art Wiederman, CPA: OK, so I know that you and I have talked in the past about, you know, obviously the dentists who are listening, they all know that patients have dental insurance. They help them submit the paperwork and submit the codes and ask for reimbursement from the dental insurance company. So talk about how important. I know that you've gotten a lot into documentation because obviously, you know, dental insurance companies and as a general rule, they there are business and they all, you know, they are, they want to make sure that the reimbursements that they give to the patients are within the rules of the plan. But there are, you know, lots of things that can be looked at. But why is documentation so important and what type of documentation do you help the dentist with that they should be knowing about?

Susan Rohde: Yeah, absolutely. So when it comes to anything medical or dental, everything is payor specific, which is unfortunate because there are a lot of payers and that you would have to contact and know your contracts with them, et cetera. Medicare usually, well, Medicare always has their own policies, and most commercial payers will follow those policies. But again, you always have an outlier that does their own things.

And I think some of the confusion with dental offices sometimes comes into play when you might have a medical condition that you're treating. So when do you assign a CPT code versus when do you assign a CDT code? And what documentation should we see? Most providers have three different types of coverage options if they're going to bill, and that's medical, vision and dental. So dental is its own entity.

If we're submitting dental claims in an in network or out of network provider, or you're engaging in using electronic communications that fall under half of which I'm assuming ninety nine percent of you are you would use those CD as in dog T codes. If you are going to assign dental insurance codes from the CDC, obviously the patient has to have access to dental insurance. That's first and foremost. If the patient does not have dental insurance, then their coverage will not pay for any other procedures performed.

Many, many patients mistakenly believe that their medical insurance will also cover dental procedures, and this is definitely not true. It's very important that your front end staff or your registration staff is able to explain this to patients, either when they call in for an appointment or when they come in. After that, it's really important to know the type of coverage that all your patients have. Again, this is a tedious thing to do.

If the patient has dental care that's related to a medical condition, then the medical insurance could be billed depending on what their coverage is. So I want to give a brief example, and then we're going to go into documentation. If a patient comes to you and they have an abscess of their gum, you in turn incise and drain it in your office. The procedure could be billed either way as a dental or a medical procedure.

The dental CDT code for incision and drainage of that abscess of the soft tissue is seven five one oh. Whereas the CPT code for the medical part of that is four one eight zero zero. So this basically means the patient can go to either their dental or medical to receive the same treatment, but different insurance companies would treat this differently. A majority of medical plans, they contain these stipulations, you know, that eliminate coverage for anything involving teeth.

A lot of patients this really harms them if they go to the emergency department for a toothache or something like that, as it's not covered. And like Art said, I want to talk briefly, thirty five thousand feet about documentation, templates and medical necessity. So in my line of work, documentation really is everything. I'm sure you've heard the old adage, if it was not documented, it was not done. That definitely goes for the dental profession as well.

When we're looking at medical specialties, we typically like to state that if they could use free text in their EMR as their electronic medical record, that is best. We urge them to try and stay away from templates because when you use a template, you get a lot of check boxes, which leads to a lot of canned or cloned documentation, meaning it looks the same for everyone and you get what the CMS or Medicare calls, quote unquote no bloat. So you get a lot of extraneous information and documentation that isn't required for that visit. Now, with dental profession, things are a little bit different there because templates are encouraged and used more often.

Typically, you will see your hygienist entering information into a computer right at the time of the visit and then you as a dentist as the provider will sign off on that later. And that is perfectly fine as long as documentation is specific to that patient for that particular data service. So I should be able to look at your schedule and say you're seeing 10 patients in a day. If I covered up the demographics on those 10 patients, each node should look different. It should look specific to that patient for that data service. And then we come into medical necessity. These are not my eloquent words. These are Medicare's by medical necessity is the overarching criteria for choosing the correct code, whether that be CPT or CDT. The documentation has to show that there was a medically necessary reason that you're seeing the patient on that date of service. You know, if it's a preventive visit, obviously that's different. If it's, you know, to fill a cavity, to do an inlay, to do an implant that needs to be shown in the documentation, why you're doing that. So, for instance, you can't just say patient's coming in with zero complaints, I'm going to put a crown on them.

Art Wiederman, CPA: Yeah, that's not going to that's not going to be medically necessary.

Susan Rohde: That would not be medically necessary. And unfortunately, on the medical side, we see that quite often. Patient here with no complaints, and then they have 16 diagnosis down on the assessment and plan. If a Medicare reviewer came in and reviewed that, they would automatically deny that claim for medical necessity. So it's very important in your documentation that you're showing exactly what you're doing for that patient on that specific date of service.

Art Wiederman, CPA: Now, Susan, I do know that there are procedures out there and there are actually, you know, dentists who use medical billing in their practices. Now I know I've heard, for example, that certain types of trauma are allowed to be billed through medical insurance and absolutely correct.

Susan Rohde: Right.

Art Wiederman, CPA: And I guess the advantage of that is that if a patient has a let's, you know, I mean, we go back to the discussion of when dental insurance was created in the 1950s, the maximums for insurance were a thousand fifteen hundred dollars. A crown was $100 and a cleaning was $9. Fast forward to 2022. A crown, depending on what area of the country you're in, is anywhere between a thousand and fifteen hundred dollars. And again, doctors, I know there's some of you, you know, we're not talking about build up. We're not talking about, you know, other things that you add to the procedure. You may be charging more than that a price. The dinosaur is going to charge a good deal more than that. But let's say for a thousand fifteen hundred dollars, a cleaning is one hundred one hundred fifty dollars. And Susan, the maximum on dental insurance is still a thousand or $1500. That has not changed. So the issue is, you know, if we can build a procedure in the dental office through a medical insurance policy, then I guess, Susan, that means that we have more room to use a dental insurance, right?

Susan Rohde: Yeah. And you're absolutely right, a trauma or an accident that you can submit to your medical insurance. Obviously, you're going to have to have some specific information. They're going to want to know the date of the injury, whether it was related to a worker's comp or an other. Unfortunately, if it happens, say, like at a school, they're going to maybe want to try to collect from the school. That is one situation. Or if it's a medical condition such as an abscess, et cetera, where patients get mixed up is what they try to go to the E.D. and you're billing these dental procedures under medical for some reason. A lot of times those get denied and I don't know the rhyme or reason. You know, payers can have their own policies, but that does seem to be one area that we see quite a bit.

Art Wiederman, CPA: I didn't tell you this either, since you're such a hockey fan, one of our clients who actually was a guest on the podcast about nine months ago, Dr. Jeff Hoye in Southern California. He's since retired. He was the team dentist for the Los Angeles Kings for about 30 years. So he actually it's interesting. He teaches dentists about a lot of sports dentistry stuff. It's really interesting.

Susan Rohde: I bet he was very busy.

Art Wiederman, CPA: Well, he would he was, he was the team dentist for the Kings. At one time, he was a team dentist for the Kings, the Los Angeles Lakers, the Los Angeles Sparks, which is the WNBA team and I believe the L.A. Galaxy. So yeah, but let's just say he was a busy guy.

So let's talk now for a second about kind of what you're seeing with dental insurance companies with payers. I mean, obviously, dental insurance companies are, you know, they can be challenging to work with at times. I mean, they all have a job to do and the dentists have a job to do. What are you seeing? What are you seeing in the area of working with these companies?

Susan Rohde: Yeah, I will say the number one reason that we see for a denial is because the claim form was filled out incorrectly. On the medical side, we use something called a CMS 1300 form. But as dental profession, you have your own claim form and it's called the J four zero zero. Now on this claim form, the following has to be included. The area of the oral cavity, the tooth system, the tooth number or letter, the tooth surface and now the next one's a big one. The description of the procedure performed and then if there's any missing teeth information.

And like I said, the number one denial we see is the claim forms not filled out correctly. And within that subset, the number one error we see is the description of the procedure is in either on there or is on their incorrectly. It doesn't have enough description, et cetera. Those are the areas that we typically see. Now we know with the new codes that are coming out which Art and I are definitely going to get into some procedures that used to be non-covered are switching to covered and those are codes. D zero one nine zero screening of a patient and D zero one nine one assessment of the patient. Again, these used to be non-covered. Now they are turning to a covered code under diagnostic and preventive, and they're covered once every 12 cases in most payer plans.

Again, you're always going to have some weird outlier that has their own policies. The this is a big one. The age limitation for individuals aged six and older will be removed from most insurance plans. Again, you could have an earlier for code D zero three three zero, which is that panoramic radiographic image that is probably number one or number two most utilized code at your practice may be following evaluations. That is a very high velocity code. It's assigned quite a bit. Oh, go ahead. No, no, you go ahead. I had one more, so benefits for restorations placed within two months may start to be denied, so you may start to see denials for D1354. And that application of carries arresting medication typically known. Yeah, it could be not fluoride, but sealant. Thank you. My brain was not working there for a second, so that could be. You may start seeing denials on that.

And one more. And then I promise I'll be done. If you are performing D3473, D3501 - 3503 on the same tooth by the same dentist's office the fees for the scaling and the root planning may not be billable to the patient for D four three four one. That's that periodontal scaling and root planning four or more teeth and also D four three four two. And that's one to three teeth. And I know a lot of this is a multiple and you may be trying to write it all down. So at the end of the podcast, I will definitely give all my information so you can get a hold of me and we can discuss further.

Art Wiederman, CPA: We're going to let you do that right now. And just take a second and talk about what you do working with dentists and you give out, Yeah, we'll do it now.

Susan Rohde: What we do at Eide Bailly is we can do a couple things. We can come in and look at your coding and your documentation. We can make sure it's thorough, it meets medical necessity, the correct claim forms, the correct codes are going out on the claim form. We can also do a billing review. So we would look at what your facility was being paid. We would get those remittance advices and, you know, match them up with the policy to make sure that you are getting paid appropriately. We can do consultant work. So if you just have a question here or there, shoot us an email, shoot us a phone call and we can answer those questions.

And my contact information is Susan Rohde. My phone number is 701.239.8540 and my email is srohde@EideBailly.com. And that's e i d as in dog e b as in boy a i l l y dot com. And typically we do these projects as a lump sum unless you're wanting more of that consultant work, and that's typically at an hourly rate.

Art Wiederman, CPA: Great. That's great, Susan. So let's spend the rest of our time talking about what's new for 2022. As I understand it, 2022 has twenty four new codes, five code deletions, twenty two nomenclature, which is way too big of a word for me and description revisions. So I'm going to let you. I mean, should you why don't you just start going down the list and talking about what's new? I know there's new sleep apnea code, so why don't you? I'm going to let you go and just start talking about what we got going on that's new that everybody should know about for 2022.

Susan Rohde: Sure. And we can cover as many as time allows. And again, please contact me if there's something I didn't cover and you want to know about. Some of the new CDT codes for 2022 are including these pre visit patient screenings, fabricating and adjusting and repairing the sleep apnea appliances which Art alluded to, the intracoronal and the extracoronal splints, immediate partial dentures, rebasing hybrid prostheses and removal of temporary anchorage devices. Obviously, there's much more and we'll touch on some of those. I wanted to really dive into CDT Code D0120, and that's that periodic oral evaluation for established patient.

Art Wiederman, CPA: And that's the big one. That's a big one.

Susan Rohde: That's a high frequency, yes, high utilized code, that's the word I was looking for. So basically what that is, according to the CDT book, it's an evaluation performed on a patient of record to determine if any changes in the patient's dental and medical health status since a previous comprehensive or periodic evaluation. The verbiage that was added to this code for twenty twenty two is the findings are discussed with the patient. So that's sort of bringing some clarity that all of the findings or lack of findings are expected to be discussed with the patient.

So if you're discussing something with the patient, what does that mean? That means it should be documented because remember, if it wasn't documented, it wasn't done. And I have to tell it, just quick story about that. I was in Montana doing a review of emergency department providers, and the head of the emergency department came to me and said on every single patient, I go back in my electronic medical record and I look at their X-rays and I look at their past visits and my coder is never giving me credit for it. And I said, that is wonderful patient care, that's awesome you're doing that. Where are you documenting it at? And he said, straight faced. Well, I don't. I just do it on everybody.

Well, unfortunately, if any of those records were subpoenaed in a court of law and you told the judge, Well, I just do it on everyone she should know. That would not stand up in a court of law. We have to have the documentation there. So if you are speaking to these patients, you know, obviously if you're going to assign that code, the findings need to be discussed. You also need to document it. And, you know, always prior to that verbiage, it was sort of implied that you were going to be discussing this with the patient. But as the CDT found out, that was not always the case. So your documentation should include what the findings of the evaluation are, whether there are any abnormal findings, or maybe there are no abnormal findings document that as well and that you discussed it with the patient.

Art Wiederman, CPA: And so, yeah, I mean, it's the same. It's we have so many similarities between what we do as accountants at Eide Bailly and what dentists have to do. I mean, I have always told my staff accountants that worked for me, the seniors, the managers that always worked for me when I ran my own firm and I was a partner here, not here at Eide Bailly, but a partner in at HMWC, our predecessor firm. As I would always say that, you know, I need you three years from now to be able to have someone look at this file or in this case, this chart. And in this case, it's an insurance company auditing and that you would be able to three years from now, if you're not here, someone would be able to read your chart, read your documentation and say, This is what I did. This is why I did it.

And we all know that, Susan, that front office administrators in a dental office get overwhelmed. They get overwhelmed with just everything that they have to do, phone calls and billing insurance and making appointments and collecting money and filing claims. But the documentation part, and again, that's on the dental team also is so yeah, I mean, because have you been involved that you guys get involved in insurance audits? I mean, if a client gets audited by an insurance company?

Susan Rohde: We absolutely do. And we also sometimes get involved if the government is leading them at the Office of Inspector General or the OIG. We have several clients that have been looked into by the OIG, and they have to, by law, have a review every year for six years. We've done numerous reviews like that. Yes, we definitely do.

Art Wiederman, CPA: And you have to you have to be able to three years from now or two years from now or one year from now to be able to with a straight face. And I say that very seriously, Susan, with a straight face look at somebody, whether they're from an insurance company or a governmental agency and say, No, we did not break this into two visits. It was one visit. I mean, you have to I mean, these insurance companies and government agencies are so powerful. And if and if you play the game wrong, they can do some nasty stuff to you, can't they?

Susan Rohde: That's absolutely correct. What happens on the medical side? I have not seen this typically on the dental side, but I haven't come across this. But on the medical side, if a government reviewer comes in, I always tell every provider when I do education, I am much nicer than a Medicare reviewer because I will actually tell you what's going on, give you a chance to fix it. If a Medicare reviewer comes in and they see a quote unquote trend and a trend to them is maybe three four five of the same thing, they will stop their review. They will tally up how many visits they think that you had in a year and they'll just, you know, extrapolate and ask for payment recoupment.

You don't, you know, sometimes you can appeal. Sometimes they won't allow that. So I would hate for that to happen if you weren't necessarily documenting appropriately because again, in your mind, I have no doubt you dental providers are doing all the work. It just has to get into the record some way.

Art Wiederman, CPA: Well, and you know, I've seen some stuff. I sell dental practices and I had a doctor come to me one time and say, Hey, Art, by the way, I just want to let you know I don't collect co-pays. And folks, they have racketeering laws and antitrust laws and really bad stuff, and I would never deal. You know, I would. I would. You know, if you're doing that, if you're not collecting copays and somewhere down the road, you want to go sell your dental practice. Now the new buyer, who is probably going to collect copays, is going to say to the patient, Oh, we need a co-payment. They're going to say, Well, wait a minute, wait a minute. The other doctor never did that. You're just trying to rip me off and I'm going somewhere else.

So you have you have these issues of, you know, run your dental practice with honesty, transparency and integrity. You will sleep much better at night and you don't want to read about yourself in the in the state dental journals.

There's some sleep apnea stuff going on, Susan. Some new stuff being one who is a someone who has. I used to have severe sleep apnea and I have found out in the last six months of three months actually that I'm down to moderate. But I've been on a CPAP machine for 15 years and it saved my life. So I'm a big proponent of sleep apnea. So what kind of new stuff do we have going on as of January one of twenty twenty two in the sleep apnea area for coding?

Susan Rohde: Yeah, that is great. So the CDT added three new codes and prior to this, prior to January 1st twenty twenty two, there was only one code available and it was D5999, which any time you have something that ends in nine nine nine, that is an unspecified code or in my world, we call them dummy codes. It's an unfortunate to have to assign those because there are a lot of hoops to jump through. You have to manually send in documentation to show what you did. You have to hand price it, et cetera, definitely lacks specificity.

So it's really great that they came out with these three new codes and those are D9974. And that's for the custom sleep appliance fabrication and the placement. D9948, that's for the adjustment. And then D9949 and that's for the repair of that. So dentists have always had this challenge when in regards to sleep apnea that the reimbursement hasn't always been stellar. Insurance reimbursement for the delivery of that sleep apnea appliance has usually required dentists to register as care providers with medical insurance companies so they can build a sleep apnea therapy through the medical with CP, as in Paul, T codes.

Now, as of January 1st, 2022, the dental codes for the treatment of sleep apnea are going to be available for dentists to use for patients with a physician's diagnosis. These codes now are going to fill that void we had before in the current dental code set. And they're really expected to make the documentation and reporting of these much easier within the dentistry practice.

I do want to note, since Art talked a little bit about money, there is typically a gap approval, and that's when the insurance has a gap in coverage with a deficiency of the in-network providers and allows that patient to see an out-of-network provider while using the better in-network benefits. That's, you know, a lower deductible cost share. And the average in-network rate for sleep apnea with an oral appliance ranges between one thousand seven hundred and two thousand five hundred, depending on the carrier and the region.

Art Wiederman, CPA: So, Susan, this is interesting. You bring this up. So if we can, if we can bill the sleep apnea appliances, fabrication and placement adjustment, repair, I mean that most of the food groups there. If we can bill it under dental insurance, the dental insurance in many cases may only cover up to a thousand or 1500 for the whole year. Again, you have to look at your policies. So I'm wondering, and you may or may not know this, but I'm wondering if. With the medical insurance companies, my understanding is if you build it through a medical insurance, the medical insurance, basically whatever the medical insurance pays, the dentists will accept, and some of these insurances pay two, three, four or $5000. Now Medicare is a different animal.

So I'm wondering if would there be a situation with these sleep apnea appliances where you would bill both? I mean, maybe bill up to the maximum for dental if the patient maybe we're at the end of the year and the patient has only used, you know, maybe two cleanings, and that's it. Now they're doing an appliance and they've got a thousand left on their dental. But, you know, do we bill the medical first and then the I mean, how does that work?

Susan Rohde: Yep, those are what's known as secondary claims, and absolutely. Or you could send it to the full thing to dental and then what's not covered, you could try to send to the medical. Absolutely.

Art Wiederman, CPA: And it requires time and it requires effort, and it requires knowledge for a front office administrator who knows how this works. I have had dentists who have implemented sleep, you know, sleep procedures in their practice. And I would fully, fully fully encourage you. You know, there's a National Association of Sleep Dental Medicine, and they do a wonderful, wonderful job of education. And folks, again, I'm telling you you will. If you do not do this in your practice, you need to seriously consider it. Now, I understand if you're 65 years old and you're going to retire in a year, maybe you're not going to get into that.

But if you are in the early or mid stages of your career, we're not even talking about, we're not even talking about earning money. We're taught which you will. And these procedures are very profitable because the overhead, you know, the appliance, the actual cost of the appliance, if it is the appropriate treatment for the patient as opposed to a surgery or a CPAP machine, the most expensive appliance that I'm aware of is probably in the five to $700 range. It's probably gone up with inflation and everything like that. And so the profit margin on these and the amount of time that you're spending is just it's a very profitable procedure.

But more importantly, and I want to pound this down and it doesn't have anything to do with dental coding is that if you do this, you are going to save people's lives. You are going to change lives for the better. Everything that you do in your dental practice is to help improve the quality of people's lives, and that's the number one reason that you come to work every day. But the sleep apnea thing. And again, I am the poster child for it. I'm convinced if I didn't get a CPAP, I might not be here doing this podcast. So anyway, Susan, anything else that we want to touch on today, we're getting towards the end of our time.

Susan Rohde: Yeah. Regarding sleep apnea, I want to make one more statement. So at your practice, it's really important if you see Medicare patients that you become a Medicare DME, that's the supplies provider. In some, you know, geographical locations, patients tend to be a tad bit older, so Medicare provider status is a must. And this is actually guidance from Medicare. They say many providers enroll as a Medicare nonparticipating DME provider and charge the patient a fee upfront, and the patient will be reimbursed directly from Medicare.

Medicare allowable ranges are from one thousand one hundred dollars to one thousand nine hundred fifty, depending on your state. But some Medicare patients have a supplemental insurance that will at times pay the entire charge amount. In those instances, the checks will go to the patients. So at your practice, you have to have a good collection protocol to ensure that the patient pays all of the payments from both their Medicare and their supplemental plan. And I know that's always a challenge trying to collect that money from patients.

Art Wiederman, CPA: Well, Susan, I know that we could probably go through every CDT code in the book and do this and that that just doesn't happen on a podcast. So I want to give you one more opportunity. Doctors, if you are needing some help and looking at your coding and how you're doing your documentation and making sure that you get the maximum bang for your buck out of patients' insurance because again, you know, we talk about we would love all of you for to be fee for service. That's just not the real world. It's not going to happen. We want to make sure that what you do as the radio psychologist, Dr. Laura Schlessinger would say, legal and not fattening, I think is what we what she used to call it is, you know, you want to do that. So, Susan, why don't you go ahead and give out one more time contact information, how people get a hold of you and then hang on as I take the podcast out?

Susan Rohde: Sure. Susan Rohde R O H D E. And my phone number is 701.239.8540. And my email is srohde@eidebailly.com and I would love to hear from all of you.

Art Wiederman, CPA: Well, if you heard from all of them, you would never get to another hockey game. That much, I can promise you. There's a lot of people that listen to our podcast and we will. I hope the. Are the Blackhawks having a good season this year?

Susan Rohde: They're not doing that great. They lost to the Wild five to zero, so that was kind of depressing. But oh, well.

Art Wiederman, CPA: Well, they're not playing right now. We're recording right in the middle of the Winter Olympics. So the NHL players are not playing in the Winter Olympics this year, so they're all continuing their season. But listen, thank you so much for sharing your time and your expertise. I mean, it's a very, very technical area, technical subject and it but it's so important that doctors can, you know, they could be losing thousands of dollars in billing incorrectly. So hang on as I take the podcast out.

Again, folks, please go to our partners website Decisions in Dentistry www.DecisionsinDentistry.com. One hundred and forty wonderful continuing education classes for a very reasonable annual cost that you'll have access to and the best clinical content and courses and articles and their website and their magazine. www.DecisionsinDentistry.com.

Again, you know the Academy Dental CPAs, www.ADCPA.org. We are a proud member of the ADCPA and you know at Eide Bailly, we do a lot of stuff. We do cost segregation. We do, yeah, we do the employee retention tax credit. We do all kinds of stuff. We do dental coding consulting, as you just learned. So we do all kinds of stuff. But anyway, give us a call. Give me a call on my office line is six five seven two seven nine three two four three and my email is awiederman@EideBailly.com.

Again, you know, if you need help with the employee retention tax credit. If you need help with the HHS Provider Relief Fund again, by the time this comes out, we're going to be pretty close to the end of the filing. And do remember, folks, if you got money in twenty twenty one from the HHS fund, you will have filing requirements. So some of you, most of you got money in 2020 and you have to file in the second quarter. I'm sorry, you have to file for the money you got in the third and fourth quarter of 2020 by March 31st, but many of you got money from phase three of the HHS and phase four, and some of you are going to have filing requirements into 2023. Isn't that wonderful, the gift that keeps on giving?

So with that said, folks, thank you for the honor and privilege of your time and the honor of being able to hopefully provide you information that will help you with your practice. We got a lot more wonderful, wonderful topics coming up that we're going to be working with you on. Remember you're right in the heart of tax season. If you haven't gotten your tax stuff together, please get it together sooner rather than later. It's be kind to your CPA year, or I should say decade, the way things have been going with IRS and everything. Exactly. And I'm hoping I am hoping that.

And oh, one more thing that I should throw out. If you guys have filed for the employee retention tax credit, whether we did it for you or somebody else did it, or you did it through whomever you did yourself. Drop me an email and let me know if you've gotten your refund yet. I mean, I don't think anybody's gotten refunds from 2020. No less 2021. But let me know if you're starting to get your refund, that's important.

So with that said, my name is Art Wiederman. I'm a proud dental director, dental division director at the CPA firm of Eide Bailly, and I want to thank you for listening to my podcast and for the Art of Dental Finance and Management with Art Wiederman, CPA. I'm Art Wiederman and we'll see you next time.