Oral Appliance Workflow (For offices that do in-house billing)

This article will outline the recommended workflow for patients with OSA. This is specifically for offices who do their own billing

Steps:

1. Schedule the patient's appointment and send them the questionnaire link. The questionnaire has crucial information in it such as insurance info, chief complaints, Epworth sleepiness scale, current medications, etc. 

2. Import patient questionnaire into DW+. For instructions on how to import a questionnaire, please click here: How to import patient questionnaire in DW+

3. Verify the patients benefits with their insurance. This is very important. Here is where you will provide them with your procedure and diagnosis codes to check coverage. You will obtain information such as the patients deductible, co-insurance, co-pays, as well as pre-authorization/gap exception requirements (if one is required and how to obtain it). Make sure you are always getting reference numbers for your calls.

Note: There is a Verification of Benefits template for your convenience, located under "quick letters" in the patient chart. Please see picture below.

4. Bring the patient in for their sleep history, exam, and workup. Document the visit in DW+ (Adding new visit in DW+) and generate your soap note (How to create soap report in DW+.) You will need this soap report prior to initiating any authorizations or gap exceptions. During this visit, you can review the verification of benefits information with the patient. Make sure to also upload the sleep study and the prescription/RX for the appliance.

5. Initiate pre-authorization and gap exceptions if needed. The reason you need to wait until after the visit to initiate, is because you need the soap report from the visit, the sleep study, and the prescription. Insurance will use all of those documents to prove medical necessity. 

6. Schedule delivery appointment. Wait for all approvals from insurance (auth, gaps) before scheduling the delivery appointment. 

7. Bring the patient in for their sleep appliance delivery appointment. Document the delivery visit in DW+ and generate the soap report. Have the patient sign the proof of delivery form.

Note: There is a proof of delivery template located under "quick letters" in the patient chart. Please see picture below. 

8. Once you have all of your ducks in a row by completing all the steps above, you can create the claim for the appliance. (Adding claims into DW+)