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what do I need to fill out to be able to bill Medicare? Also for medical are we only aloud to bill PPO medical insurance?
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Hi Guest!
Great question. Are you looking to bill Medicare for oral appliances for Obstructive Sleep Apnea, other services, or both?
As for what types of medical insurance you can bill as a dental practice, no it does not only have to be PPO. Of course, as an out-of-network provider, PPO plans do generally offer out of network benefits (unlike HMO's who generally only offer in-network benefits), however we do work with many offices who bill HMO insurance as well either by submitting gap waivers (to honor the patient's in-network benefits to an out-of-network provider, when there is not a provider in-network who can perform the services within a reasonable distance to the patient), or by enrolling as an in-network provider for the HMO.
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I was looking to bill both
ok thank you! Is it worth applying to be in network for an HMO or do you get better pay out when you submit for the gap?
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Rank: Administration
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Hi guest!
Great question. Applying to be in-network with an HMO is definitely a practice preference. The upsides to it are that you don't have to worry about not getting a gap approved due to another provider nearby already being in-network, it reduces the patient's out of pocket cost so you generally see a higher acceptance of treatment, as well as not having to wait the additional time and put forth the additional effort of requesting the gap. The downside is you generally will be agreeing to a negotiated allowed amount that is less that you would want to charge.
Hope this helps!
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Regarding the Medicare 855S Application. How does a DME know of they need to be accredited (what are the factors?) And what does accreditation entail?
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Rank: Administration
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Hi guest!
Great question. Dental practices enrolling as DME suppliers with the 855s application in order to bill for custom made oral appliances for OSA are exempt from the accreditation program. You will still receive an on site visit from the national supplier clearinghouse after your application has been accepted, but are exempt from the accreditation program.
Hope this helps!
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Rank: Guest
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Hi,
My dental office does not participate in Medicare, but we are wanting to start delivering custom oral appliances for Sleep Apnea. I have a couple questions about acquiring a DME license. We have the application and are in the process of completing it.
To apply for a DME license, does the business have to have it's own NPI (type II)? Our two dentists each have their own individual Type I NPI, but when we go to the site to pay for the DME application, it states that neither NPI is found in the NPPES database.
On page 10 of the DME Application, "Products and Services Furnished by this Supplier": we currently do not furnish any supplies, but are applying to supply custom oral appliances for sleep apnea, so do we need to mark anything in this section? It doesn't look like there is an option to select oral appliances.
Thanks!
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
Great questions. As for the NPI, most dental practices do enroll as Medicare DME suppliers using their Type II (entity) NPI on the Medicare DME application (855s application). However, if the business is set up as sole proprietor rather than an LLC for example, a Type I would be used instead.
As for the products and service to be furnished section, for custom made oral appliances for OSA, you will select the options "orthoses: custom fabricated'
Hope this helps!
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Rank: Guest
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