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Good morning. Each week, we worry about making a big intro in your inbox. Turns out, we're not alone. A Florida orthodontist went viral on TikTok with a Willy-Wonka-like entrance into the operatory. You have to see it to believe it.

In Today’s Edition:

• Melatonin to get to sleep

• ‘Sleep Cocktail’ to stay asleep

• Vitamin D3 and OSA connection

• Medical Billing OSA 101

7-minute read today👇

Clinical Corner

🥼Use the clinical corner as your secret weapon to impress your colleagues and patients!

🔑Key Takeaways

1/ Melatonin: A Game-Changer in Battling Primary Sleep Disorders?

What Happened & Why It Matters

A recent meta-analysis is bringing melatonin into the spotlight as a potential aid in battling sleep disorders. Spanning 19 studies and involving 1683 subjects, melatonin showed significant efficacy in improving sleep parameters. The research indicates that it can reduce sleep onset latency by around 7.06 minutes and increase total sleep time by roughly 8.25 minutes. It also enhances overall sleep quality.

Given its mild side-effect profile compared to other pharmacological options, melatonin presents itself as a promising alternative. This is particularly relevant for individuals undergoing treatments like oral appliances, myofunctional therapy, and laser therapy. It could represent a significant advancement in managing sleep apnea effectively.

Practical Takeaways

1. Incorporate Melatonin in Treatment Protocols: Melatonin can be a vital addition to existing treatment protocols due to its positive effects on sleep latency and duration.

2. Tailored Dosages for Enhanced Outcomes: The study suggests that higher doses and longer durations of melatonin use could have greater impacts on reducing sleep latency and increasing total sleep time, paving the way for personalized treatment approaches.

3. A Safer Alternative: Melatonin appears to be a safer alternative to other pharmacological agents for treating insomnia, especially for patients concerned about the side effects of other medications.

4. Educate Your Patients: Dental specialists can play a crucial role by educating patients about the benefits of incorporating melatonin into their treatment regimen, fostering better sleep management strategies.

*Disclaimer: Melatonin supplements may cause side effects such as dizziness, headache, or nausea, and have been associated with a potential delay in the onset of puberty in children and adolescents. Please consult a healthcare provider before use, especially for young individuals.

2/ Recommended sleep supplements (Andrew Huberman)

Are your patients tired of tossing and turning in the wee hours of the night? If so, this week’s focus on actionable solutions might just be the answer they've been searching for. We're zooming in on a range of supplements that might just hold the key to a more restful night's sleep. Here's the skinny from Andrew Huberman.

What Happened & Why It Matters

Dr. Huberman unveiled a variety of clincially proven supplements that might cater to different sleep issues: from trouble falling asleep to waking up in the middle of the night. In particular, myoinositol, with a recommended dose of 900mg, can potentially aid those who find themselves frequently awake at ungodly hours, helping them fall back asleep more quickly. It also boasts benefits for mood enhancement.

For those vivid dreamers who find themselves jolted awake, steering clear of theanine may prevent midnight waking due to intense dreams. Meanwhile, those struggling to nod off in the first place might find respite with magnesium threonate or bisglycinate, supplements that not only facilitate quicker sleep onset but also offer cognitive support and neuroprotection. Another valuable ally in the fight against insomnia is apigenin, a chamomile derivative that eases anxiety, helping to quiet the mind before sleep.

Practical Takeaways

💡 Personalized Supplement Strategy: Suggest a trial period where patients can experiment with different supplements separately for a week at a time to identify which works best for them. This method helps in isolating the most effective component without blending them initially.

💡 Dream Intensity Consideration: For patients experiencing vivid dreams that disrupt sleep, advise against the use of theanine as it can potentially exacerbate the issue, leading to waking up in anxiety.

💡 Holistic Approach to Sleep Enhancement: Encourage patients to explore the potential benefits of a deeper sleep on their mental and physical well-being, and to approach supplement usage systematically and responsibly.

💡 Resourceful Information: Recommend the website examine.com as a reliable source for understanding the various effects of different supplements, backed up by scientific evidence.

3/ Spotlight on Vitamin D: A New Perspective in OSA Management?

The Big Picture:

Obstructive Sleep Apnea (OSA) seems to have a puzzling connection with the growing concern of Vitamin D deficiency. This deficiency, now seen alongside OSAS, is speculated to play a role in the progression of the disorder through avenues such as immune modulation and inflammation. However, studies show conflicting data, indicating a need for research without the influence of confounding factors like obesity.

Why It Matters:

Vitamin D deficiency is on the rise globally, paralleling the risk factors and co-morbidities seen in OSA. This trend suggests a possible interconnection, with the vitamin potentially influencing OSA development and its associated health issues. The promising angle here is the potential role of Vitamin D supplementation in curtailing cardiovascular incidents, which are common in both conditions, at a relatively low cost.

💡 Take It to the Practice

For the Pragmatic Practitioner:

1. Screening Alert: Considering the potential link between Vitamin D deficiency and OSAS, it might be beneficial to include Vitamin D screening in clinical evaluations.

2. Supplemental Strategy: Due to its affordability and positive impacts on common comorbidities, incorporating Vitamin D supplementation in your treatment plans could be a viable option.

3. CPAP & Vitamin D Dynamics: Stay informed on the latest studies examining the impact of CPAP treatment on Vitamin D levels to hone your treatment strategies.

4. Research Radar: Keep an eye out for more conclusive research elucidating the complex relationship between Vitamin D and OSAS.

Next Steps?

Encourage collaborations to initiate research in this area, potentially leading to more comprehensive and effective OSAS management strategies.

Business of Sleep

📈Better businesses = more lives saved!

Medical Billing for Sleep Apnea Oral Appliance Therapy

Dentists are playing an important role in treating sleep apnea. About 1 in 4 Americans have this condition, according to the American Academy of Sleep Medicine. Offering this service in your practice not only benefits patients but also brings in extra money. However, billing for sleep apnea treatment is different from other dental services. In this article, we will discuss how to bill medical insurance for sleep apnea treatment, which dental codes to use, and details about Medicare coverage.

Medical Billing for Sleep Apnea Oral Appliance Therapy

Oral appliance therapy (OAT) is often approved by medical insurers for sleep apnea treatment. This is mainly because it's cost-effective and addresses a significant health risk. However, billing for OAT can be complex due to policy limitations, pre-authorizations, high deductibles, or C-PAP requirements.

To successfully bill medical insurance for sleep apnea treatments, dentists should:

1. Get approval for OAT.

2. Prepare necessary medical provider documentation, including the NPI number and updated HCFA forms.

3. Include sleep apnea questions in the regular medical history intake process.

4. Set clear financial expectations for medical insurance reimbursement.

Pre-Authorization for Sleep Apnea Oral Appliance Therapy

Pre-authorization is a step where insurers assess the medical necessity of a procedure. It can be time-consuming but necessary. Staff training can help integrate it smoothly into your billing process.

During pre-authorization, insurers may ask for specific information. It is good practice to initiate a pre-pre-authorization phase to set the process in motion. This stage often requires a diagnosis or referral from an M.D., including a letter of medical necessity and, usually, a sleep study.

Additionally, recent patient imaging, like a pano X-ray or CBCT, may be necessary. Contact the insurance company for a list of required pre-authorization elements and use the appropriate forms from their website to avoid delays. If pre-authorization is denied, consult the insurer to understand their concerns before re-submission or appeal.

Home Sleep Testing for Pre-Authorization of Oral Appliance Therapy

Various types of sleep studies are available, and regulations for prescribing them may vary. In-lab polysomnogram (PSG) is the standard method, but it can be inconvenient for some patients.

Most insurers accept home sleep test (HST) results. Depending on your location, either dentists or only M.D.s can prescribe these tests. If allowed, consider acquiring equipment to rent to patients. This will enhance your practice and facilitate coordination with third-party organizations.

Requirements for Recent Sleep Studies for Oral Appliance Therapy

Generally, insurers accept tests conducted within the past 24 months, except for Medicare patients, who require tests from the last 12 months. Always verify this with the insurer.

Workflow for Sleep Apnea Insurance Billing

To streamline the billing process for sleep apnea treatments, collaborate with expert organizations in the sector. They offer user-friendly software to help doctors track the billing process and manage reimbursements. Registering with these organizations can be cost-effective and increase margins as volume grows.

Workflow Steps:

1. Upload insurance information to the organization's website.

2. Check the patient's insurance eligibility.

3. Order the intraoral appliance.

4. Design, fabricate, and ship the appliance.

5. Fit the appliance in the patient's mouth and ensure comfort.

6. Bill the medical insurance.

7. Receive reimbursement.

8. If necessary, bill the patient for the remaining charges.

Medicare Coverage for Sleep Apnea Oral Appliances

Medicare only covers custom devices designed specifically for treating obstructive sleep apnea.

"For the oral appliances used in obstructive sleep apnea (OSA) treatment, coverage falls under the Durable Medical Equipment benefit. To be eligible for reimbursement, the requirements outlined in the relevant Local Coverage Determination must be met. All follow-up care within the first 90 days after receiving the oral appliance is considered to be included in the payment for the device." (Source: CMS.gov)

Dental Codes for Sleep Apnea

Diagnosis Code (ICD10): G47.33 (adult & pediatric)Service Rendered Code (HCPCS/CPT): E0486

Note: This code applies to custom-fabricated mandibular advancement devices used in obstructive sleep apnea treatment.

Home Sleep Study Codes (CPT):

• 95800

• 95801

• 95806

Home Sleep Study Codes (G):

• G0398

• G0399

• G0400

(Sources: CMS.gov, AASM.org)

CDT 2022 Codes:

• D9947

• D9948

• D9949

Contact the specific insurer to confirm which codes are appropriate.

Why Your Practice Should Offer Sleep Apnea Oral Appliances

Offering sleep apnea treatment can benefit your practice. It allows you to serve a larger segment of the population and bridge the existing gap in healthcare provision. Moreover, it's a service that complements your existing offerings and adds a potential revenue stream.

Something Sweet

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Miscellaneous

😅P.S. … I forgot something

FDA Experts Blow the Lid Off Ineffective Nasal Decongestant🤧