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Tip of the Week: Who is AIM? 6-22 to 6-26, 2015

Friday, June 26, 2015

Did you miss the last tip of the week? No problem, view it below!

Code S8262 for TMD appliances discontinued as of June 30, 2015

 


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Tip of the Week!

Who
is AIM?

 

Any dental practice treating patient's suffering from Obstructive Sleep Apnea (OSA) and snoring may have come across AIM Specialty Health, or very well may in the future! 

AIM Specialty Health assists medical insurers in specialty benefits management. So what does that mean?

Many insurers have enlisted the services of AIM to manage the pre-authorization request review process for sleep apnea services, such as oral appliances for OSA and sleep testing services. Simply put: AIM sets the coverage criteria & guidelines, and processes your pre-authorization requests instead of the insurers internal department.

Here is a link to AIM's main website for more information:
http://www.aimspecialtyhealth.com/

From this site, you can view AIM's Sleep Management Program details, view FAQ's on the program, as well as download a copy of their clinical guidelines (a.k.a. medical policy) for sleep services.

View program information here

Download AIM's sleep guidelines here

View FAQ's here


 


AIM's clinical guidelines for sleep services include information on:

  • CPT and HCPCS Codes addressed by the policy
  • Sleep testing guidelines for home and in-lab tests
  • APAP and CPAP guidelines
  • Bi PAP guidelines
  • Oral appliances for OSA guidelines (page 20-22)


In the oral appliances for OSA section, the guidelines for patients diagnosed with severe OSA state:

"Treatment with OA is appropriate for patients with severe OSA (apnea/hypopnea index [AHI] greater than 30) meeting at least one of the criteria (1-3) below:

1. The patient is not a candidate for positive airway pressure therapy; or

2. Positive airway pressure therapy has not been effective despite a 45 day trial and participation in a positive airway pressure compliance program; or

3. The patient has tried continuous positive airway pressure (CPAP) but has not been compliant despite a 45 day trial and participation in a positive airway pressure compliance program."


For patient's diagnosed with mild to moderate OSA, the guidelines state:

"Treatment with OA is appropriate for patients with mild or moderate OSA meeting both of the following criteria (A and B) below:

A. At least one of the following:

1. AHI greater than or equal to 15 and less than or equal to 30; or

2. AHI 5–14 with any of the following: excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, treatment-resistant hypertension (persistent hypertension in a patient taking three or more anti-hypertensive medications), ischemic heart disease, history of stroke;

AND

B. At least one of the following:

1. The patient is not a candidate for positive airway pressure therapy; or

2. Positive airway pressure therapy has not been effective despite a 45 day trial and participation in a positive airway pressure compliance program; or

3. The patient has tried CPAP but has not been compliant despite a 45 day trial and participation in a positive airway pressure compliance program; or

4. The patient prefers to use an OA rather than PAP as the initial therapy"


 

Nierman clients can view any past NPM Study Group on demand!

The sessions are organized into categories to help you find what you're looking for - or something you didn't even know you were looking for! Follow the links below to see all of the available recordings in each category:


1. Sleep Apnea Training


2. TMD-TMJ Training


 

3. Oral Surgery Training

4. General Medical Billing Training

5. Marketing Training

6. Training - misc. topics


7. Recorded E3 Full Webinars



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