When the patient decides to move forward with treatment, we have a few forms that need to be signed. Although we have already had a discussion regarding informed consent, we have the patient sign an informed consent agreement. You can make the agreement as simple or as complicated as you want. The American Academy of Dental Sleep Medicine can provide you with a good one. Patients fill out an Epworth Sleepiness Scale at their initial appointment so that we can prove they are experiencing excessive daytime sleepiness to insurance. We also have patients sign a financial arrangement form. There is a lot of information in this, as we want patients to know we are filing medical insurance on their behalf as a favor. In addition, it touches on the fact that there is no money-back guarantee, and if the insurance mails a patient the check, he or she needs to turn it over to us. Patients also fill out a CPAP intolerance form, whether they have tried CPAP or not. If a patient has never tried CPAP, then we still have him or her fill out the form, stating that oral appliance therapy is being used as first-line therapy in mild to moderate cases. And lastly, we have patients fill out a proof of delivery form. Because Medicare requires this, we do it for every carrier. Phew . . . tired yet? That’s a lot of paper and a lot of trees.
At follow-up appointments, we have patients fill out follow-up questions about snoring, energy level, and sleep quality. We also have them fill out an Epworth Sleepiness Scale, which allows us to objectively measure their progress on fatigue.
The final piece of paperwork is letters to patients’ physicians sent throughout treatment. In fact, this is the best marketing I do. In order to send these, I must do SOAP notes, which medical insurance requires as well. Let me explain. SOAP is an acronym for Subjective, Objective, Assessment, and Plan/Procedure. Subjective notes include how the patient is feeling (i.e., the chief complaint). I usually put these in quotation marks, so it is in the patient’s own words. I include history, symptoms, other therapies attempted, family history, social history, etc. The objective portion includes measurements or what I observe (i.e., my findings). I include blood pressure, pulse, weight, height, BMI, sleep testing numbers, and Epworth Sleepiness Scale score. A is for assessment. This is where the differential diagnosis, diagnosis, and the patient’s overall progress are recorded. Finally, I include the plan or procedure done. It is best if you can get your whole team on board and even do SOAP notes in your dental software for dental procedures.
There you have it. It may seem like a lot, but it is all doable. My biggest call to you is to get trained and get trained now. Stop making snore guards and start saving lives. If you are medical billing for patients, then more patients will move forward with treatment. The more patients that are being treated, the more trees that will be cut down. But don’t worry. We have a strong timber industry here in Idaho.
Forms mentioned in this article:
- Patient intake form
- Informed consent agreement
- CPAP intolerance form
- Proof of delivery form
- Financial arrangement
- Snoring, energy level, and sleep quality follow-up questions
- Epworth Sleepiness Scale
- Letter to the patient’s physician
Erin Elliott, DDS, is a practicing general dentist in Post Falls, Idaho, where she has successfully integrated dental sleep medicine into her busy general practice. She lectures extensively and leads a hands-on workshop focusing on practical strategies for successful implementation of sleep medicine into the general practice. She is an active member of the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine. She is a past president and diplomate of the American Sleep and Breathing Academy. Contact her directly at [email protected].
