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Sleep Apnea by Larry Twersky

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Providing OSA Therapy

Dental treatment is "black and white." Root canals and fillings are either complete or not; a crown is expected to last several years once it is placed. Most dental procedures have a beginning and an end, which define successful outcomes.

Let's compare dental treatment to medical treatment. In medicine, if a physician can help a patient improve his/her condition by 50 percent, the treatment is considered a success.

Even more astonishing, the treatment does not need to be successful at all for the physician and DME to get paid by insurance! Can you imagine dental insurance allowing this? But medical insurance does, and therefore the practice of medicine has a very different set of rules. No software can prepare the team for the different mindset, documentation, process, monetization and outcomes that are unavoidable.

Vocal minorities of dentists dedicate their practices to sleep apnea; but, even fewer dentists will admit to how lucrative working with sleep apnea patients can be while maintaining a general practice. A small percent of these outliers may already be successful at monetizing treatment for sleep apnea, and they are not the target of this article.

The information here is for the general dentist who is told by that certain, small group, "The water is great. Spend the $25K-$50K with us and jump in." Before you drown, consider this: You can't do it all in sleep apnea! The practice of medicine won't allow it.

By attempting to treat OSA alone, you are, in essence, "outside your scope of practice" in the United States! Leave the quarterback duties to the MDs and allow them to guide the overall outcome of treatment.

Remember, according to the existing regulations in most states, a dentist may screen for sleep apnea patients and prescribe testing, such as sleep tests (however, not in New Jersey), but only medical doctors can provide a diagnosis. And, only a medical doctor will determine (write a prescription) if and when:
  1. a patient is ready to use a CPAP
  2. a patient is ready to use an oral appliance by itself, and, best yet
  3. a patient is ready to utilize co-therapy
Surprisingly, most professionals (including MDs) do not understand the benefits of co-therapy and the benefits the dentist can provide. If they did, oral appliance therapy (OAT) would be prescribed for every patient with positional apnea.

People's jaws fall back at night when the patient falls asleep or lies on his/her back (supine position), due to gravity or deep sleep/REM. This causes masks to leak and not fit properly. This also causes the CPAP to work harder and increase pressure as the airway closes down. In addition, the elastic over the jaw on the full face mask exacerbates the situation.

A dentist can eliminate almost all positional apneas, which in most cases are 50 percent of the problem, with a simple oral appliance set at a bite of "edge to edge."

Many dentists agree that "edge to edge" will cause little to no bite issues or discomfort with patients. Positioning the jaw allows the MD to set the CPAP pressure to a level that is almost 50 percent lower than the original setting, giving the patient greater comfort with the therapy.

The Essence of Co-Therapy

By working together, the dentist addresses OSA by minimizing the vulnerability of the jaw falling back and constricting the airway; while the medical doctor addresses the diagnosis by monitoring the patient's compliance with CPAP therapy - the definition of "co-therapy."

A dentist, with a custom oral appliance, can potentially help patients increase CPAP compliance by positioning the mandible and opening up the airway; thus, lowering the pressure of a CPAP and allowing for a smaller, more comfortable CPAP mask, such as nasal pillows.

Integrating OSA Treatment

Why recreate your practice? Is it really necessary to invest thousands of dollars in software and training? The answer is no! Do what you do best: fabricate custom oral appliances to manipulate the jaw and open the airway, at the same time addressing any TMJ/TMD issues that either already exist or may become a problem in the future.

Investing thousands of dollars in medical billing software and home sleep testing equipment is not sensible for the dentist who is just "getting started" or treats only a few OSA patients per month. While oral appliance and CPAP therapy are covered by most medical PPO insurance policies, a dental office that must learn to work with insurance reimbursement protocols will face big hurdles and non-payment. When taking into account the amount of front-office time and training required to see any type of reimbursement from medical insurance companies, the amount of profit is most likely minimized.

Medical insurance differs greatly from dental insurance, especially since oral appliance therapy will be denied multiple times by insurance companies before payment is rendered, if ever. Medical service organizations (MSO), such as Snoring Management, have experienced staff and sophisticated medical billing software already in place and can navigate through the minutiae and protocols of medical insurance companies, ultimately allowing the dental office to focus on patient care. Such business models are already successfully operating in various states across the county.

Working with the Medical Community

Most dental practices do not employ staff to work offsite and build professional relationships with the medical community in order to generate patient referrals. Thus, the process of reaching out to the medical community becomes blatant cold-calling. There is certainly an advantage to having access and being referred to an already built-in network of medical sleep doctors.

Role of the MSO

MSOs are readily available to manage the entire revenue cycle; however, partnering with an MSO to manage only OSA patients can offer a more prudent way to successfully integrate sleep medicine into a dental practice. The purchase of new software is not required and there are little to no upfront investments. While an MSO may take a larger percentage of revenue collections than standard billing companies, the rewards can outweigh the risks.

The first year of integrating sleep medicine into a dental office may be better spent working with an MSO, which can reduce the dentist's financial risk and the need to retrain the entire dental staff. An MSO can act as a catalyst in the beginning and can eventually withdraw from the process when the dental practice reaches a pre-determined comfort level to manage on its own.

Snoring Management was started as an alternative solution to helping dentists successfully integrate sleep medicine into their practice and make a profit. The company is unique in that dentists are given access to built-in, referral networks of medical doctors and sleep labs, which may minimize a dentist's exposure and liability in the medical arena.

Snoring Management, which specializes in coordinating cotherapy for OSA patients, guides their doctor's patients through the entire process. In addition to managing the tedious, yet necessary, protocols of collecting reimbursement from insurance companies, the team provides an added value to the doctors and their patients by offering a higher quality of customer care. Each patient is followed throughout the process, from scheduling sleep tests to getting set up with co-therapy.

Benefits of a Team Effort

Successful treatment for obstructive sleep apnea is primarily dependent upon the patient's compliance. The primary challenge becomes: "How do we help patients achieve that compliance?" Sleep apnea is a serious medical condition that should be addressed by all health-care providers who are specially trained in sleep medicine; and fostering the cooperation of the dental and medical specialties provides patients a higher level of quality care.
  • The patient receives a more guided and comprehensive form of treatment.
  • The dentist becomes part of the medical team, but is not required to shoulder 100 percent of the burden.
  • The medical doctors have the opportunity to work with dentists to minimize the vulnerability of the jaw falling back and constricting the airway, yet still guide the overall outcome of treatment.
  • Working with a qualified MSO requires little to no upfront investments, brings together both dental and medical specialties, maximizes reimbursement and provides coordination of patient-care.

Dentists who want to treat sleep apnea successfully must adapt a mindset of allowing the medical doctors to guide the outcome of treatment. When a dentist addresses even a small portion of the greater problem, the dentist's contribution can be significant enough to increase a patient's compliance and affect a successful therapy outcome.

Author's Bio
Larry Twersky is the CEO of Snoring Management and 1-800- Snoring, based in Tarzana, California. He is dedicated to helping doctors treat snoring and sleep apnea. To find out more about integrating treatment for sleep apnea into your practice, visit www.snoringmgt.com.
Dentaltown Magazine
September 2025
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