PHYSICIANS - Frequently Asked Questions
1. Does a patient need a sleep study before I treat them with an Oral Appliance?
The Practice Parameters of the American Academy of Sleep Medicine, which provide the Standards of Practice for the management of sleep disorders, specifically require diagnosis by Polysomnography (PSG - the overnight sleep laboratory test). Currently, virtually all medical insurance carriers require diagnosis by PSG in order to provide reimbursement. SMN Affiliate Dentists are trained to comply with all provisions of the AASM Practice Parameters.
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Trained to practice only within AASM guidelines, SMN Affiliate Dentists understand well the processes that limit risk management in the treatment of these patients. Since guidelines require diagnosis by polysomnography, the training includes the proper relationships with local sleep laboratories and sleep specialists.
OSA is a medical disorder that can lead to diminished longevity and quality of life. Now that the disorder has been proven and accepted as a risk factor for cardio-vascular disease, the dental office needs to practice within the medical model. An SMN Affiliate Dentist is thoroughly trained in all aspects of that model, including:
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appropriate examinations |
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proper informed consent |
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medical documentation to support EM insurance coding |
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proper communications with medical colleagues |
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proper follow up patient management systems in accordance with guidelines |
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medical chart requirements |
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HIPPA protocols |
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medical insurance chart requirements to avoid unintentional fraud |
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continuing education to be aware of changes in procedures and techniques in this dynamic field |
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SMN Affiliate Dentists benefit from the training and ongoing support by experts in the field of medical insurance. Contracted exclusively by SMN, our insurance experts will provide assistance to our network of affiliate dentists in:
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Credentialing |
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Pre-verification / Pre-authorization services |
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Optional Billing Services |
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Billing Software Training and Management |
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Claim Denial / Appeals Management |
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Practice Management Services to assure "Clean Claims" |
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Ongoing Education of Insurance Staff at the Dental Office as Relevant Changes in the Insurance Industry Occur |
SMN assists affiliate dentists in the all-important trust relationship with the insurance carriers. When they are assured that the office is practicing within the medical model, reimbursements are virtually always assured, subject to the limits of the patients' policies.
Using SMN's proprietary treatment algorithm, coding, documentation, ongoing support and network, reimbursement for oral appliance services is generally rapid and dependable. Denials will be minimized, patient out-of-pocket fees are minimized and patient acceptance rates become virtually 100%.
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SMN Affiliate Dentists are trained in the identification and management of side effects associated with the use of mandibular advancement appliances. The literature review completed by the Standards of Practice Committee of the American Academy of Sleep Medicine revealed that there are minor and major side effects associated with this therapy. Some patients discontinue treatment if muscle or joint discomfort is significant. A majority of patients have no symptoms and the use of these appliances are well within their adaptive capability.
In the minor category, tooth, muscle or joint discomfort may be occasional, mild in severity and not sufficient to cause discontinuation of use.
There can be long-term occlusal changes, but with the advent of morning exercises, and good patient education and monitoring, the risk of occlusal change has been significantly reduced or virtually eliminated.
It is a consensus of opinion of the Academy of Dental Sleep Medicine (dentalsleepmed.org) that TMD (temporo-mandibular joint dysfunction) is not at all necessarily a contraindication for this therapy. If the source of the TMD is a derangement of the joint within the capsule, this therapy can often be helpful. The risk of disk displacement exists, but is mitigated by proper patient education and clinician judgment.
Myofascial pain syndrome is possible in some patients, and again, can be mitigated by proper patient education and clinical practice.
Generally speaking, the benefits of managing sleep disordered breathing to reduce the risks of cardio-vascular disease and death or injury from daytime somnolence, far outweigh the risks of appliance use in virtually every patient. If TMD is diagnosed, and the patient can afford to wait until the joint has been stabilized through splint therapy prior to airway management, then that is a viable option. If not, often TMD and airway dilation can be accomplished simultaneously.
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