In an episode of The Patient First Podcast, Sleep Group Solutions President, John Nadeau sat down with Dr. Bryan Laskin to discuss an often-overlooked aspect of sleep apnea: dental sleep medicine. Dr. Laskin is an author, dentist, and entrepreneur fascinated by any opportunity to provide dental patients with more connected, integrated, and comprehensive care.

During the interview, SGS President emphasized the importance of raising awareness about sleep apnea. Dental sleep medicine, a specialized field within dentistry, offers innovative solutions that can significantly improve the quality of life for individuals struggling with sleep apnea.

The Patient First Podcast is an invaluable platform for sharing insights, experiences, and expertise in dental healthcare. We are grateful for the opportunity to contribute to the conversation surrounding sleep apnea and dental sleep medicine, and we remain dedicated to supporting initiatives that prioritize patient-centric care.

Sleep Group Solutions empowers dental professionals to exceed their clinical and financial goals with dental sleep medicine. We are committed to providing the highest quality of education and training. Allow us to change the way you view dentistry through a complete turnkey solution that produces better patients, better practices, and a better YOU.

To listen to President John Nadeau’s episode on The Patient First Podcast, watch here: bit.ly/48WJub3

The Complex World of Medical Billing in DSM

Billing for DSM services is far from straightforward. The challenges stem from the unique position that DSM providers occupy in the healthcare system. They bridge the gap between dental care and medical care, treating sleep-related disorders like obstructive sleep apnea (OSA) through oral appliance therapy. As a result, dental sleep medicine providers experience medical insurance challenges they’ve never experienced in the dental world.

Challenges Faced by DSM Practitioners

1. Code Confusion: DSM providers must use specific medical billing codes, such as Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes, to bill for their services. These codes can be complex and change over time, in addition to having code modifiers and requirements on when and who can bill for them add to the complication.
2. Out-Of-Network Billing: 99% of dentists are out of network with all medical insurance plans and thus must bill insurance as an OON provider. Out of network coverage is limited or non-existent, leading to high patient out of pocket costs and lower case acceptance.
3. The Disappearing GAP Waiver: In the early days of dental sleep medicine most providers would attempt to get a GAP or Network Insufficiency waiver for patient coverage (essentially paying you as an in-network provider because there is nobody in-network nearby who can offer the service). Most GAP requests in 2023 are blocked leaving the dentist with no options for insurance payment.
4. Software Confusion: Medical billing from a dental office requires learning complicated new software and rules for when and how various codes can be billed.
5. Physician Expectations: Growing your DSM practice involves establishing referral relationships with area physicians. In a recent survey of Sleep MD’s their #1 hesitation about referring to a dental office for a sleep appliance is the fact that the dentist is out of network and the patient costs would be prohibitively high.

Streamlining Medical Billing in DSM

In the face of these challenges SGS set out to develop a patient, physician and dental practice friendly billing option that allows for consistent, predictable, reimbursement while taking the burden away from dental admin teams. As part of the DSM business builder program SGS client practice will benefit from:

1. In-Network Reimbursement: The SGS Sleep Impressions practice is a nationwide network of DSM professionals with pre-existing in-network contracts for most major medical payers including BCBS, Aetna, Cigna, United Healthcare, Humana, TriCare and the VA Healthcare System. New partners are able to benefit from these established relationships and contracts
2. End-to-End Diagnostics & Billing: Our platform includes a telehealth system for face-to-face visits with a board-certified sleep medicine physician. The physician will order and deliver sleep tests and prescribe oral appliance therapy to be filled by our network dentists as in-network providers. Our patient advocate team will verify benefits, collect co-pays / deductibles from patients and schedule them for records appointments back in the dental office.
3. Nationwide VA Network: Our Sleep Impressions practice is in-network coast-to-coast with the VA. New partner practices are added to existing Optum or TriWest contracts to be able to provide covered sleep appliance services to VA patients nationwide.
4. “Hands off” case presentations: Dental teams will never have to guess benefits, determine co-pays, collect fees from patients or try to figure out how much to charge – it’s ALL done for you. Let SGS handle the billing and you focus on providing the best clinical outcomes.

The journey toward streamlined medical billing in dental sleep medicine is in reach. By embracing specialized software, ongoing education, and effective strategies, DSM practitioners can simplify the billing process and focus on what they do best – providing quality care to patients with sleep-related disorders.

If you’re ready to learn about adding Sleep Medicine to your dental practice, call us now at 1-888-608-4965 or request a free consultation!

Understanding CPAP Noncompliance:

CPAP therapy involves wearing a mask connected to a machine that delivers a continuous stream of air pressure to keep the airways open during sleep. While effective, some patients find CPAP treatment uncomfortable or claustrophobic. They may experience issues with mask fit, air leaks, or noise, which can lead to noncompliance.

The Role of Dental Sleep Medicine:

Dental sleep medicine focuses on addressing sleep-related breathing disorders, including sleep apnea. Dentists who specialize in this field can provide alternative treatments to CPAP therapy, with a particular focus on oral appliances.

Making Oral Appliances for CPAP Noncompliance:

• Assessment: The first step is a comprehensive evaluation of the patient’s sleep apnea condition. Dentists should gather medical history, conduct a thorough examination of the oral and pharyngeal structures, and possibly recommend a sleep study.
• Customized Design: Based on the patient’s specific needs, the dentist designs a custom oral appliance. These devices are typically made of acrylic and fit comfortably in the mouth, resembling a mouthguard or retainer.
• Adjustment and Fitting: Dentists carefully adjust and fit the oral appliance to ensure it’s comfortable and effective. Patients may require some time to adapt to wearing it during sleep.

Advantages of Oral Appliances for CPAP Noncompliance:

• Comfort: Oral appliances are often more comfortable than CPAP masks, making them a viable alternative for noncompliant patients.
• Non-Invasive: Unlike surgery, which is another option for sleep apnea, oral appliances are non-invasive and reversible.
• Portable: Oral appliances are small and easy to transport, making them suitable for travel.
• Increased Compliance: Many patients find it easier to comply with treatment when using an oral appliance, leading to better long-term outcomes.

Dentists’ Role in Improving Sleep Health:

Dentists who offer oral appliances for sleep apnea treatment play a crucial role in helping patients achieve better sleep health. They can collaborate with sleep physicians, provide patient education, and offer ongoing support.

Noncompliance with CPAP therapy doesn’t mean the end of the road for patients with sleep apnea. Dentists specializing in dental sleep medicine can make a significant difference by providing effective and comfortable oral appliances tailored to individual needs. By taking on this role, dentists contribute to better sleep health and a higher quality of life for their patients.

If your patients or a loved one struggles with CPAP noncompliance, consider adding dental sleep medicine to your dental practice! Call us at 1-888-608-4985 or request a free consultation.

The Rise of Dental Sleep Medicine

In recent years, Dental Sleep Medicine has emerged as a pivotal solution to address sleep apnea and other sleep-related disorders. Approximately one in four adult dental patients suffers from sleep-disordered breathing, highlighting the vast potential this field offers for dental practices. Patients often seek non-invasive alternatives to CPAP machines, and dentists are uniquely positioned to provide these solutions through Dental Sleep Medicine.

In-Office Consultation: The First Step

An in-office consultation is the foundational step to tap into this potential. Here’s why it matters:

• Education and Training: Dental Sleep Medicine is a specialized field that requires both knowledge and skill. In-office consultations provide dentists and their teams with the essential education they need to understand sleep apnea, its diagnosis, and the available treatment options. This education is a powerful tool that empowers you to offer comprehensive solutions to your patients.
• Integration with Your Practice: Implementing Dental Sleep Medicine seamlessly into your existing practice can be a challenge. In-office consultations offer personalized guidance to ensure the program is smoothly integrated into your daily workflow. This includes training your clinical and administrative teams and adapting your practice to efficiently manage sleep patients.
• Access to Expertise: In-office consultations are led by experienced clinicians who have successfully navigated the path you are embarking on. They understand the challenges you might face and can provide real-world insights and solutions. These experts offer guidance on medical billing, marketing strategies, and physician referral programs, streamlining your journey into DSM.
• Reimbursement Solutions: The best clinical protocols and solutions for your patients are only good if you can be reimbursed for it. DSM is often a dental practice’s first foray into medical insurance billing and this is frequently a daunting task. SGS has this completely solved with a pain-free revenue cycle management program where the entire benefits, payment, collections and claim process is handled outside of your office. This enables most patients to receive IN NETWORK benefits for their treatment which means guaranteed consistent reimbursement for your practice. You focus on the best clinical outcomes and leave the rest to us.

The SGS Dental Sleep Medicine Business Builder Program

One of the leading providers of in-office consultations is Sleep Group Solutions (SGS). Their Dental Sleep Medicine Business Builder Program is designed to equip you with the knowledge, tools, and support needed for a successful practice. The program combines classroom and hands-on education, ongoing coaching and mentoring, and proprietary diagnostic and airway imaging technology.

SGS offers a unique advantage by providing both lecture and hands-on training, including Eccovision airway imaging and home sleep testing technology. Their seminars and on-site practice consults are taught by highly credentialed clinicians who have walked the same path and practice what they teach daily.

Flexible Learning Options

Recognizing that every dental practice is unique, SGS offers various continuing education options. In addition to in-person seminars, they provide customized in-your-office CE programs, a comprehensive online CE course, and free CE webinars on various topics each month. This flexibility ensures that even if you have limited resources or time constraints, you can still access high-quality education in Dental Sleep Medicine.

In-office consultations are the gateway to success in DSM. They provide the foundational knowledge, integration support, and access to experts that every dentist needs to thrive in this rapidly growing field.

Take a DSM Test Drive

Not every practice is a perfect fit for DSM.  The next step for your office would be to schedule a consultation with one of our Dental Sleep Medicine Experts to educate your team and experience and see the entire patient protocol from start to finish in your office.

Request your FREE Dental Sleep Medicine In-Office Consultation today!

Abstract:

Abstract:

In October 2017, the American Dental Association (ADA) adopted a policy on dentistry’s role in treating sleep-breathing disorders including obstructive sleep apnea (OSA). It emphasizes that all dentists should screen for sleep-breathing disorders and that dentists should be the professionals who fabricate oral appliances (with a physician’s prescription).

Sleep-breathing disorders are “recognized as potentially serious medical conditions caused by anatomical airway collapse and altered respiratory control mechanisms,” the ADA said in a written statement to Sleep Review. “As experts in the oral cavity, dentists are able to question patients about pertinent symptoms during routine dental evaluations, and refer patients to physicians for diagnosis. The policy was adopted to address dentistry’s growing role in the multidisciplinary care of patients with [sleep-breathing disorders].”

In a news release from October, the ADA lists key takeaways that describe the role dentists should play:

• assess patient risk for sleep-breathing disorders as part of a comprehensive medical and dental history and refer affected patients to appropriate physicians
• evaluate the use of oral appliance therapy and provide it for mild and moderate OSA when CPAP fails
• identify and address the side effects of oral appliance therapy
• communicate patients’ treatment progress with referring physician and other healthcare providers.

Another point made in the policy is dentists treating sleep-related breathing disorders should stay up-to-date on the disorders and training in dental sleep medicine with continuing education. When asked what education the ADA will be providing dentists about how to screen for sleep-breathing disorders, the ADA advised that is currently under consideration.

The policy, written by the ADA Council on Dental Practice, is a result of an evidence brief on the use of oral appliances for sleep-breathing disorders, which was developed by the ADA Council on Scientific Affairs. The ADA’s governing body, the House of Delegates, reviewed and made comments for the policy, which were incorporated into the final draft before the association finally adopted it this past fall.

The evidence brief that inspired the policy shows there is a large portion of people who could have undiagnosed sleep-breathing disorders that could potentially be identified and treated by dentists who abide by these policy guidelines. It states that the prevalence of OSA is “estimated to be 3% to 7% in men and 2% to 5% in women. Prevalence is higher (greater than 50%) in patients with cardiac or metabolic disorders, relative to the general population.”

The ADA does not yet have data on any recent increase in sleep-disordered breathing screenings at dental offices or how quickly the policy is being rolled out.

Posted by Dillon Stickle, an associate editor for Sleep Review.