Well before the American Dental Association (ADA) made their strong recommendation for oral appliances last year, dental sleep medicine showed no signs of stopping its steady climb into the medical mainstream. For the founders of imagn Solutions, Orem, Utah, accommodating growth and helping more dentists succeed is a matter of the right dental sleep software, medical billing software, coaching, and education.
Crystal May, co-founder and COO, has seen the leaner days when dentists had fewer options. “I've been heavily involved in dental sleep medicine for over 10 years and medical billing for more than 17 years. At that time, there was nothing available. There was no consistency in protocols and rules, medical billing was unknown; we had to find the codes, do the research, and often when we called insurance companies they would refuse to talk to us, we were a dental office. Honestly, they didn’t know what we were talking about, they could not even find the codes.”
Fortunately, 2018 and beyond is a “totally different world.” Awareness is high among members of the public and clinicians, but many dentists are still finding it difficult to jump on the bandwagon. The American Sleep and Breathing Academy (ASBA) sat down with Crystal May to discuss the opportunities for dentists who are willing to commit to the burgeoning field of dental sleep medicine.
ASBA: How do you fit into the industry?
May: imagn Solutions focuses on solutions for sleep and medical billing, that were built specifically for dentistry. Our complete solution for dental sleep medicine includes software, medical billing services, coaching, education, and much more. Our software and medical billing platform streamlines the process to overcome the most common obstacles offices face. Whether it is an office new to dental sleep medicine or experienced in dental sleep medicine, we can improve their process. Our software is cloud-based, so it can be used with any practice management software. We are the solution for general dentistry practices, we are built for them. We have also worked for diligently to get an advanced connection in Dentrix. This connection eliminates the need to duplicate enter patient information, treatment plans and clinical notes, to name only a few. With an imagn Sleep tab in the patient Dentrix chart, the workflow in seamless.
ASBA: How does diplomat status fit into a dentist’s preparation for this field?
May: Diplomat status is not tied to insurance payment. However, the single biggest differentiation between success and failure in dental sleep medicine is how trained and committed the dentist is. If you have gone through and received diplomat status, it means you have put the effort in, you have studied, you have taken the tests, and you have passed. The likelihood of you succeeding is far greater than others. We think diplomat status has real value for dentists.
ASBA: Are the insurance companies on board these days with dental sleep medicine?
May: Dental sleep medicine is one of the most common billable dental services. About 85% of insurance payers have policies that pay for oral appliances when the patient has a diagnosis of OSA. The process is tried and true and as long as you follow the protocols and rules, patients can now have benefits for the care they really need. When I surveyed a large group of MD’s, they all said that a dentists ability to successfully bill medical insurance was a requirement for them to refer. This is a huge part of bridging the gap between medicine and dentistry.
ASBA: What was the situation a decade ago?
May: It was exponentially different 10 years ago. Back then, from an awareness perspective, most of the sleep specialists I worked with had never worked with a dentist trained in dental sleep medicine and few patients had coverage for OAT. Sleep specialists were not following their own organization’s recommendations to refer for certain cases. CPAP was the standard of care as far as the payers were concerned no matter the severity of the diagnosis.
ASBA: What’s the situation now?
May: Now it's quite the opposite. There are hundreds of sleep specialists who now recommend oral appliances as the first line of treatment for appropriate cases. And for the first time in my experience, patients are coming in educated and asking for their dentist to help. Home sleep testing is readily available and treatment outcomes are much predictable. Medical billing has become more manageable, and a majority of policies allow for oral appliances.
ASBA: What are some of the factors that made that possible?
May: These improvements are a product of the industry showing a significant improvement in the ability to handle patients and follow protocols. More comfortable appliances, consistent outcomes in medical billing and the advancement in technology, like our software, 3D scanning and access to home sleep testing are all key components. The organizations created for this division of dentistry have been critical in these advancements, and I believe we are just at the tip of the iceberg. The ADA made their strong recommendation for dentists to screen for sleep related breathing disorders. This will have a big impact on new dentists getting involved, and a company like imagn Solutions will be necessary for them to be successful.
ASBA: What services do you offer to dentists?
May: As mentioned earlier, we have our imagn Sleep software, with an integrated medical billing portal. We also offer medical billing software and service for all dental services, such as surgery, perio treatment, diagnostics, implant procedures, grafting, any procedures related to a trauma, and more. We have onsite coaching and consulting. We are accredited educators, and teach both doctors and teams throughout the country on both sleep and medical billing. As I speak for other organizations and universities, I focus on the team training aspect, really helping with the practical implementation. The now what, that is often the million dollar question after a clinical course. Dentists hire my company to come on site and to help them improve the dental sleep medicine process in their everyday protocol.
We pride ourselves in our screen-every-patient protocol. It's the idea that every dentist in the country is being asked to participate in dental sleep medicine, whether they want to actively treat OSA or just screen and refer, it’s up to them, but it's not an option for dentists to stay out of this space. And honestly, once they see the life changing effects sleep treatment can have on their patients, I don’t know why they wouldn’t want to.
ASBA: For dentists who do general dentistry, how difficult is it to get involved in dental sleep medicine?
May: Dental sleep medicine can be a challenge to incorporate. Adding something new to an already busy dental practice can be overwhelming, for both the doctor and the team. A clear understanding of procedures and protocols, team training and software are a must! We have created the digital workflow so that dentists can integrate this life-saving protocol of screening and treating sleep-related breathing disorders and still be efficient in their practice.
ASBA: What are the typical hurdles for dentists?
May: One of the problems is team training. It starts with paperwork and having comprehensive conversations. In a lot of offices, the dentists will take programs and residencies and be diplomats, but their staff has no clue about the science behind sleep and the passion they need for this. That's an obstacle.
Dental sleep medicine gets a bad rap because many dentists have tried and failed because they did not start with the right tools. They were surprised when implementing sleep did not work well. Many educators in this space have not been in the providers' shoes. A lot of educators don't work in small towns with high turnover and poor patients, or they don't work in super busy offices. These dentists already have obligations and obstacles before they ever even try to incorporate sleep. We try to work within the existing dental system and not disrupt the practice. Even for some of my most successful customers who are changing lives and very successful, it took them six months to a year to fully incorporate sleep into their protocol. You must have a realistic expectation. This is not going to be like selling electric toothbrushes.
ASBA: What about medical billing?
May: Medical billing is another big obstacle. There are a lot of rules and regulations. In 2019, most medical payers will no longer accept any paper claims. If you don't have a software that can connect to a clearing house, you will get rejections on paper claims. That is already happening. They literally mail the claim back to you. You must have electronic claims submission. Not to mention the liability. Not to scare anyone away, but be careful and diligent in the rules and documentation. Medical Billing is black and white, and we pride ourselves in only teaching the RIGHT way to do things.
ASBA: What would you say to those that have not started to implement dental sleep medicine in their practices?
May: Now is the time to get started. You can get the support you need. You can separate your practice and be a hero to your patients. Imagine how your patient will feel when you have medical insurance cover some of their expense. When you identify a condition that basically no one else will find, you have a fan. Dentistry, in my opinion, has the potential to change health as much as any healthcare provider.
About Crystal May
Crystal May – Co-Founder and COO of imagn Solutions, a company dedicated to helping dental practices be successful in dental sleep medicine through education, consulting, team training, medical billing and more. With over 17 years of medical billing experience, 10 with an emphasis on sleep treatment, she is considered a leading educator on the topic. Having owned and managed multiple dental practices, she has mastered the process of implementation, overcoming the obstacles associated with dental sleep and shares that knowledge with dental practices throughout the country.