Don’t Lose Sleep Over The Small Things


In my first clinical semester of nursing school, I quickly realized it was not the field for me, that’s ok, I would be married soon and live happily ever after. Shortly after the wedding, a friend of a friend knew of a dental assistant opening in a pediatric office. Perfect opportunity! I’ll see if hygiene may be an option for me by working as an assistant! I left the hospital I was working at and my career as a woman in dentistry began! After a fast year of being a dental assistant I was offered an opening in the business office of the practice. I found the perfect position for me and before I knew it almost 17 years had passed, 2 children, 2 houses, several cars, pets and gray hairs later I knew the position had run its course and I went off to seek other adventures.

I worked in a library for 6 hours, not my bliss. I worked as an accountant at an auto dealership, not my bliss, I was a full-time stay at home Mom, found my bliss but reality check was that we were a 2- income household for so long, it was difficult with 2 pre-teens to suddenly to be a 1 income household.

Back to being a woman in dentistry!

I accepted a position as an office manager for a general dental office and that’s where my real journey begins!

“YES!! I would love to go with you when you open your new practice” said an unsuspecting office manager to the associate dentist after just 4 days in that position (gulp…me)!

A few months later I find myself in a beautiful, brand new office learning by trial and error how to bill medical insurance in a dental office. As the doctor was learning how to treat patients diagnosed with obstructive sleep apnea with oral appliances I was learning the administrative aspects of dental sleep. We were now following a medical model and working with medical insurances which were as far from working with what I had known for so many years in dental. Top view of dental insurance policy with stethoscope, hypodermic syringe, plaster, gauze, tincture and tape.A dental office working with medical insurance? That was completely unheard of back in the olden days, try explaining that to a patient! I had to work closely with the medical insurance companies, so they could understand what we were treating and why. There were no policies in their systems for these services. I was a long way from the earlier years of my career as a woman dentistry at the pediatric office. Billing for a diagnosed medical condition is as far from billing a crown and pulpotomy on tooth j as you can get. Talk about frightening, but I embraced the challenge!

In Florida with Robin Morrison and Colleen Cady Huff working with Dental Consultants Connections

A few years later, I was asked to co-present with the doctor on medical insurance in the dental office at the annual meeting of the American Academy of Dental Sleep Medicine. In preparing for the presentation, I put pen to paper and started documenting what I was presently doing, what had worked and what hadn’t worked. Shortly after, at the urge of my dentist, I was consulting offices all over the country to get dental sleep policies and protocols in place, how to work with medical insurance companies and procedures to make their office run smoother and provide the best care for the patient.

My daughter and future son-in-law

Then Medicare came on the scene! Just when you think you know something, everything changes. I learned early that one of the basics of understanding Medicare is knowing how it runs. Congress makes a governing decision and it then filters to the local jurisdictions and it is up to them to implement the ruling- this is an important thing to understand when working with Medicare, the driving force isn’t as we would see things from our view regarding this medical service, it is mixed with government views, this may be why it can be so confusing. But fear not, all the rules and regulations are in black and white and readily available for you to peruse. One of the hardest parts of starting with Medicare is that you must make some business model decisions before you enroll. It is simple to decide what is best for you once you understand your options and yes, doing nothing is an option, a very poor option but an option.

I am a proud “Nonna” and Military Mom! Re-enlistment ceremony

With Medicare knowledge under my belt, I was on top of the world, my claims were being authorized when needed and paid when submitted, smooth procedures were in place….and then the doctor decided to move and sold the practice, MY practice, my baby! My professional space in the world was gone. I had all this knowledge and nowhere to implement it. After several months of remote freelancing, I found a part-time position with a dental office starting dental sleep medicine. It was exciting to get another practice up and thriving, once it was I realized I was getting stagnant, so I once again ventured out and accepted more consulting and speaking engagements and became a remote employee for a sleep office in Boston and continue to be a remote employee to this day.

I am so grateful to the dentist that dragged me into this field even though I was kicking and screaming (in my head anyway).

Fun with some of my AADOM peeps at the annual meeting in Scottsdale, AZ

In the decade and a half in this field, I have had more personal and professional disappointments than I can recall. A child deployed to the middle east, cancers, losses and more proposals that I have submitted to various organizations than I can mention have been rejected, and yet, as us gals do, we can stay strong and carry on. One of the most disappointing or disheartening things I have seen in this profession are the ethics of some of the companies that are marketing to dentists and selling them unnecessary products and services and teaching them unethical ways of submitting claims.

What an honor to earn office manager of distinction in 2015!

Even with so many ups and downs, my career in dental sleep medicine has been amazing. A small group of women in dentistry that are pioneers in this field took me under their wings and helped me immensely. Along the way, I was honored to be nominated for office manager of the year for the American Academy of Dental Office Managers (AADOM) and was recognized as being an office manager of distinction that year. I completed the fellowship with AADOM that same year and found a local dental study group. Among other highlights of my career was being invited to join the Medicare DME Outreach and Education Provider Advisory Group (POEG) for jurisdictions A and D. It has been quite a journey and I still find this field fascinating and just when you think you know all the ins and outs, something changes! I continue to work as a practice administrator in a dental office limited to dental sleep medicine, putting my theories into practice every day and keeping my finger on the pulse of the field.

AADOM (American Academy of Dental Office Managers) Fellowship ceremony Nashville, TN Fall, 2015

That is my story in a nutshell and why I can truly sympathize with the office team that says “My doctor came back from a meeting and now we are treating sleep apnea, I don’t know where to start! I was once there too, feeling like a deer in the headlights, wanting to talk patients out of scheduling appointments because I didn’t know where to start or what to do. That is MY WHY- the reason why I coach, continue to learn and work with offices that are implementing dental sleep medicine in the practice. As I reflect the years since starting in dental sleep medicine, the field has come so far and is still on the cusp of being something bigger.




SOURCEFeature Image: © Sven Vietense First Image: © petzshadow All other images courtesy of Jan Palmer
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Practicing dental sleep medicine is a goal for many, but a reality for few. The complexity of the insurance reimbursement process has provided enough frustration that many dental offices abandon the potentially lifesaving and profitable area of practice. Over the years, I have developed strategies designed to connect the essential services patients require to the well-deserved insurance reimbursement. Having worked with offices from all over the county, they have had learned the information necessary to establish functional and sustainable billing protocols for sleep apnea procedures. My focus is on proper medical documentation and the break-down of policies for Medicare and private insurances. Medical coding and billing is often last picked for the proverbial dodge ball game because big insurance doesn’t seem to want dental teams to understand the process. However, that is all medical billing is–a process, and it can be learned. If you looking to implement dental sleep medicine into your practice, are struggling with workflow of dental sleep medicine or have an established practice that needs to advance to the next level, I have has established highly effective processes and have the knowledge to share so you can implement DSM to the highest level of care for your patients. In addition to speaking and consulting roles, I am on the Provider Outreach and Education committee for Medicare DME for Jurisdictions A and D, has co-authored an e-book Medicare: What Every Dentists Needs to Know NOW, vice-president on the board of directors of the WNY Dental Managers Group, am a Fellow of the American Academy of Dental Office Managers and a facilitator of the American Academy of Dental Sleep Medicine (AADSM) team training series while holding a management position with a practice exclusive to treating sleep apnea, putting theory into practice every day. I am an active member of ADMC, DCC and AADOM. Jan Palmer, FAADOM


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