Sleep Billing: Lori Skipper of BTO Billing and Consulting On The Challenges of Oral Dental Device Implants For OSA

Lori Skipper began her education with the goal of becoming a CNA but quickly realized her talents lay strongly in medical billing and credentialing. She is completely self-taught, having extensively researched and studied procedures, codes, and rules. Lori began working as a biller and credential expert 15 years ago and started BTO in November 2016 in Palmetto, Florida.
Lori has excellent advice for physicians on increasing patient satisfaction, taking full advantage of technology, and how payment reform may offer opportunities for dentists willing to expand into sleep medicine.
Lori, what medical specialties make up the bulk of your business?
I have done billing for OB/GYN, critical care, orthopedic, internal medicine, sleep physician, nephrology, urology, and DME, including oral dental devices.
You work a lot with various types of practices that deal with sleep medicine. What are the challenges facing those with patients dealing with or at risk for sleep disorders and how do you help them successfully overcome those challenges?
On the topic of sleep disorders and sleep medicine, practices generally encounter one, if not all, of the following challenges.

  1. The first challenge is building awareness for screening of sleep disorders such as OSA (Obstructive Sleep Apnea).  Effective and routine patient communication about the importance of being screened and treated for OSA is something every office staff member must be trained on and become comfortable talking about.  We help educate the staff members as well as the providers to be sure they understand the importance of screening patients.
  2. Each individual insurance plan has their own guidelines for sleep disorder treatment.  As an example, one may require a new sleep study be done every year, one may allow every three years, while another may allow five years.  Verifying these guidelines and the patient’s eligible coverage under his/her specific plan prior to rendering services is a MUST.  We verify with every insurance company every time for their protocols regarding sleep tests and the mandibular advancement device to be sure they are covered and how often.
  3. And, lastly, getting more dentists to recognize the importance and need to screen ALL of their patients for OSA has been a challenge.  This needs to become second nature for dentists just like their process for screening oral cancer.  We train and teach the dentists as well as their staff on the proper communication about the screening so that they can be comfortable talking about it and understand the urgency of their patients being treated.

What other services do you provide to your clients?
I obtain authorizations, submit claims, and follow up to be sure they are processed and paid at the correct level. I want to see patients receive the treatment they want and deserve, so I treat every case as though I’m trying to get an authorization or a claim paid for myself or one of my family members.
I work with providers to gain credentials and contracts with medical insurance companies. It is extremely important to be credentialed with medical insurance companies to obtain payment for services rendered. Credentialing and contracting are very different things.
I also teach offices how to run an efficient front office, from answering the telephone to collecting co-pays and deductibles to switching from paper charting to EMR.
 What sets your organization apart from others who provide similar services?
I provide top-notch customer service to my clients. I get back to them within 24 hours if they leave me a voice message or email—it’s typically within a few hours of contact. I am highly available to my clients; they do not have to go through someone else before reaching me.
I also get claims processed and paid correctly in a very abbreviated time because I scrub the claims before I submit them to be sure all the data is correct so there are no hiccups.
What direction would you like to take your business next?
I would like to take on more consulting clients. I have a great deal of experience that I can impart to help clients provide better customer service, run a more efficient front office, and improve their claims management.
What do you think is the biggest opportunity for your business in the coming years?
First, more offices are switching from paper charting to EMR, which helps the process of obtaining authorizations and getting claims processed and paid. Second, more providers are recognizing the need to outsource their medical billing. Third, more dentists are seeing the need to treat patients for obstructive sleep apnea by providing them with a mandibular advancement device.
Patient satisfaction is impacting everything from reimbursement to physician online reviews to social media. In your opinion, what three or four things should every medical practice be doing today to ensure high levels of patient satisfaction?

  • They should offer patient portals for patients to fill out initial paperwork, submit questions to their provider, request refills on their prescriptions, and request appointments.
  • They should make sure they have enough staff in their practice so their employees are not overwhelmed and wearing too many hats. When that is the case, they provide less than excellent customer service, which can lead to patients leaving the practice.
  • Providers need to be aware they may not know everything about running a successful office and that it’s okay to get outside help.
  • The knowledge in the office should not be in the hands of one or two individuals. Physicians need to stay in the loop regarding their financial status, particularly aging claims.

The evolution of reimbursement and payment reform for Medicare, Medicaid, and even commercial payers has been a roller coaster ride in recent years. What do you think every medical practice in your specialty should be doing today to ensure they are getting paid correctly?
They should continue CE courses pertaining to their specialty and take advantage of seminars and training opportunities.
Do you think payment reform will ultimately increase, decrease, or keep the revenue consistent in your business or specialty?
I believe reimbursement for the mandibular advancement device (to treat obstructive sleep apnea) will increase as more dentists recognize the need to enter the realm of sleep medicine. I’m seeing more insurance companies getting on board and allowing a mandibular advancement device to be used instead of CPAP.
Please share three ways you believe technology has improved your business or specialty.

  1. Cloud-based software to access EMR systems and store data
  2. The ability to access claims and patient data via a mobile phone
  3. The security provided by cloud-based storage: there is no need for external hard drives that can be stolen

What three things do you believe every organization in your specialty should be doing to protect their data and how extensive are the consequences if they fail to do so?
They should use a cloud-based EMR and be vigilant about knowing what is going on in their practice. If they fail to do this and there is a data breach, they can find themselves involved in a lawsuit that could cost them their practice
What aspects of your role in healthcare would you advise your younger, less experienced self to pay more attention to?
Providing excellent customer service. Patients are not an inconvenience—they are your paycheck. Also, if you do not have a passion for what you do, you’re in the wrong field and it’s time to look for something else.
What aspects of your role in healthcare would you tell yourself to pay less attention to?
Grandiose gestures of appreciation by my superiors. I would also caution myself about taking on too much responsibility and not delegating!

1 thought on “Sleep Billing: Lori Skipper of BTO Billing and Consulting On The Challenges of Oral Dental Device Implants For OSA”

  1. Hi Michael!
    This was a great read! As healthcare advances and technology changes, it\’s great to see how businesses and owners are taking measures to provide superior customer service not only to the physicians but the patients as well. Like Lori, I have a medical billing company and I\’m always asking myself, \”How can I make things better?\” Lori provided a lot of insight into her success! Thanks for sharing this!


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