The intersection of dental care and sleep medicine represents a significant development in healthcare.
Dentists play a critical role in managing sleep-related disorders,
specifically in treating sleep apnea.
The evolving phase contributes to better patient care and triggers unique challenges in dental billing
services. Understanding intricate billing and Insurance policies causes dentists to hesitate to perform
the practice efficiently. However, experts in the field have highlighted several billing methods and
models for certified dentists to
streamline the practice. Moreover, open conversations with
patients and referring providers about your billing practices will help considerably to improve your
This guide will lead you to explore the importance of efficient dental billing in dental sleep solutions and the critical challenges involved in the methods and strategies to streamline the billing workflow.
Traditionally, dental sleep medicine fellowship focuses on all sleep-related disorders, including
snoring and obstructive
sleep apnea. According to everyday practice, a new definition of dental sleep
medicine has been formulated, including all the aspects of diagnosis and treatment of other sleep
disorders touching on dentistry, such as orofacial
pain related to sleep, xerostomia, hypersalivation,
gastroesophageal reflux disease, and bruxism.
Dental sleep lab focuses on diagnosing and treating sleep-related breathing disorders, with obstructive sleep apnea (OSA) being the most common condition addressed. Dentists provide oral appliances as part of OSA treatment and are essential to the multidisciplinary approach to sleep medicine. The demand for these services has increased with the awareness of the health risks of sleep apnea with dental sleep apnea clinics.
Among the various steps of the procedure, dental care providers often encounter the challenge of
handling efficient billing for dental sleep medicine. Here's why:
Complex reimbursement - OAT billing involves working with dental and medical Insurance
plans with different rules and requirements. Properly assigning treatment with the correct codes and
documentation is essential.
Patient coverage verification - variations in insurance policies and guidelines pose another challenge for professionals in patient coverage verification as it is a significant step of the practice to know what's covered and what isn't.
Medical Necessity Documentation - to secure reimbursement from medical insurers, dental practices must provide thorough documentation demonstrating the medical necessity of oral appliance therapy (OAT).
Coding Accuracy - ensuring accurate coding is the fundamental aspect of practice to prevent claim denials. Professionals must use correct codes aligning with the specific sleep disorder and treatment provided.
Compliance Rules - dental sleep medicine residency and other healthcare billing are subject to evolving regulations and complaint standards. Keeping up with these changes is crucial to avoid specific penalties.
Commercial medical Insurance as an In-network Provider - Commercial Medical
Insurance is one of the
reliable options that may cover OAT under their policies. The process may vary when dentists intend to
negotiate reimbursement in terms of the insurer, geographic location, market share of the insurer, and
some other factors. The American Academy of Dental Sleep Medicine (AADSM) offers members template
letters to support such in-network application requests. Considering the differences of each policy,
commercial insurers keep updating the plan. Hence, dentists must review policies regularly set by the
insurer you bill and the insurers that are new to you.
However, in case the dentists fail to attain in-network contracting as feasible, commercial insurers may offer waivers allowing an out-of-network provider to offer OAT coverage at in-network rates. These gap exceptions are a reliable alternative to in-network billing for specific dental sleep medicine courses.
Medicare and Medicaid Billing for OAT - Medicare covers OAT under the durable medical equipment benefit (DMEB). For billing Medicare or referring physicians as medicare providers, the dentists must enroll as a DMEPOS supplier with the medicare program. As per the region or country the patient belongs to, Medicare limits the types of appliances for reimbursement. Medicaid may also cover OAT under certain conditions, such as state-by-state policies. Dentists must check Medicaid policies per your state before deciding on the service implementation.
Prepayment Method for Billing Dental Sleep Medicine - Dentists may substantially benefit from the prepayment model/fee-for-service as in the 2022 poll of newer AADSM members, 76% offered a prepayment mode. The approach begins with patients having to pay the dentist's office in full, either all payments at once or in installments as arranged through a third-party payer. Applying the approach may help the dentist select the most appropriate appliance for the patient's condition regardless of the insurer's list of approved devices or reassessment of your fee structure.
To provide the best quality care in dental services, you must be crystal clear about informing the patients of the value added in service while adopting a fee-for-service payment model. If you provide additional service with commercial insurers, you may submit a claim and offer all insurance benefits to the potential patient. Even when introducing a claim under a fee-for-service model, the dental practice must document the procedure accurately per the requirements to receive healthy benefits.
To document and bill dental Insurance for oral appliance therapy, dentists must use these codes to
ensure accuracy and efficient billing. However, dentists are not bound to use these codes for billing
the services. However, they can use these to request insurers to cover some or all of these procedures
as mentioned in the policy contract.
The ADA implemented three HCPCS CDT codes to cover oral appliance therapy effective January 1, 2022.
D9947 - Custom sleep apnea appliance fabrication and placement
D9948 - Adjustment of custom sleep apnea appliance (including titration)
D9949 - Repair of custom sleep apnea appliance
Snoring and sleep apnea treatment may pose several challenges for professionals in achieving the quality
procedures desired. However, a strategic approach can improve efficient dental sleep medicine billing
Introducing integral training and support programs - to understand the complexities of dental and medical insurance processes, billing staff must be accommodated with adequate training in dental sleep therapy billing
Utilizing Dental Practice Management Software - investing in dental practice management software offering billing features will make it efficient to manage claims, code assignments, and patient information.
Verifying Patient Coverage - Verifying insurance coverage for dental sleep medicine procedures as part of the patient onboarding process can reduce surprises for both practice and patient
Document thoroughly - recording detailed information about the patient's condition, treatment, and medical necessity makes the clear and complete documentation required for the claim approval.
Stay Updated - keeping up-to-date on the changes in dental sleep medicine billing codes and regulations by joining relevant professional associations and attending industry events will assist considerably.
Outsourcing Billing for Dental Sleep Medicine - MedsDental Billing and Coding company relies on experienced and efficient practitioners to streamline many dental practices. Outsource your dental sleep medicine billing and improve the Accuracy and efficiency of claim processing with us.
Are you facing the dilemma of choosing the right partner to rely on for outsourcing the intricate dental sleep medicine billing while dealing hardly with physicians to deliver oral appliance treatment? MedsDental Billing and Coding Services are offered dynamically to support your billing while maintaining practice efficiency. We automate multiple processes with dental sleep medicine software for billing efficiently with AI technology and save time, cost, and resources. At the same time, you can start improving the quality of your dental sleep medicine treatment.