by Dr. Mark Murphy
Throughout history, technological leaps have profoundly reshaped healthcare delivery, improving outcomes, patient experiences, and practitioner profitability. Time Magazine notably selected Johannes Gutenberg as the “Man of the Millennium,” underscoring technology’s enduring influence on humanity. In dental sleep medicine (DSM), this principle resonates deeply, emphasizing how technological advancements can not only elevate patient care but also ensure dentists receive predictable and timely reimbursement.
Why Has DSM Struggled to Take Off?
Despite approximately 100,000 dentists attending sleep courses, fewer than 2% (1,500–1,750) have successfully billed medical insurance. This staggering drop-off reveals the greatest barrier to DSM’s success: the complexity and inefficiency of reimbursement processes. We’ll return to this and discuss a predictable solution later in this article.
While about 7,500 dentists have delivered at least one appliance, inconsistent payments and extensive claim denials create frustration, discouraging ongoing engagement.
FDR’s famous sentiment – ”a fair day’s wage for a fair day’s work” – echoes deeply here, highlighting how vital predictable financial returns are to fostering sustainable growth and enthusiasm for DSM. It’s very difficult to stay on course if you cannot get paid. Chris Sager, the long-retired CEO of the Pankey Institute, reminded me of this delicate balance between patient care and financial viability. He preached that “unrewarded altruism ultimately fails.” Oral appliance therapy is a behaviorally rewarding service, but the warm fuzzies can’t pay the bills. The 20-year decline in dental reimbursement rates, and the subsequent challenge to our incomes, leaves little room for pro bono care.
Growth Gaps in DSM
According to industry data, only 450–500 practices nationwide consistently produce more than ten appliances monthly. Increasing that benchmark to fifteen cuts this number in half. The root cause? Inadequate and inconsistent reimbursement systems. The clinical procedures are easily mastered. But without predictable payment workflows, dentists struggle to scale beyond a handful of cash-paying cases, severely limiting their ability to provide the care patients deserve – and to grow their practices effectively.
This minuscule number of successful, and potentially sleep-only, practices reflects those who have “figured it out.” Although several medical billing services exist in this arena, timely financial reimbursement is still more illusion than reality. These ~500 practices have found a way to work with their billers and solve for reimbursement – perhaps not at the desired speed, but at least at a pace that allows for some financial success.
Technology: Bridging Patient Care and Profitability
Albert Einstein cautioned, “It has become appallingly obvious that our technology has exceeded our humanity.” Yet, in the context of DSM, technology enhances rather than diminishes our humanity. Consider CPAP machines and Inspire implants, two giants in the sleep treatment industry. CPAP manufacturers like ResMed achieve billions in revenue with impressive profit margins, thanks largely to structured reimbursement protocols.
Inspire, utilizing advanced medical technology, anticipates hitting nearly $1 billion in sales by 2025 with unprecedented margins. These successful financial models starkly contrast the struggles DSM faces – despite oral appliance therapy (OAT) demonstrating superior patient adherence and comparable or better clinical efficacy.
OAT offers significant advantages – patients prefer it, adherence rates are higher, and outcomes often surpass those of traditional CPAP. Yet DSM’s financial model has lagged, making widespread adoption elusive. The question remains: if OAT is clinically effective and financially sensible, why hasn’t it dominated the market?
Emerging platforms are now addressing reimbursement pain points by integrating AI-powered workflows, automated documentation prompts, and pre-auth accelerators. One such platform, Restfull powered by IAOS, has begun to address these gaps, offering features like reduced claim cycles and guided compliance. If technological advancements can bring oral appliances to the efficacy and adherence tables, why not bring predictable reimbursements as well?
Physician opinions on the effectiveness of oral appliance therapy are trending in our favor. It’s getting easier to get face time with them, discuss recent advances, and champion precision treatment as a viable, non-surgical alternative to CPAP. Understanding and managing the medical reimbursement environment will align oral appliances for prompt and improved reimbursement.
Why This Matters: My Personal Journey
My passion for dental sleep medicine stems from helping dentists struggle with complex billing processes, unpredictable reimbursements, and compromised clinical protocols. After decades of learning it the hard way – and witnessing talented professionals become discouraged by financial uncertainty – I realized we could leverage technology and coaching to remove these barriers.
I’ve worked through the difficult tasks of documentation and medical billing with external partners. Restfull provides the technological structure and predictable reimbursement we need – and this new generation of devices simplifies treatment.
My years at ProSomnus taught me how to build solutions that met the unmet needs of customers. Those devices – scientifically designed, supported by countless studies, and made from superior materials – transformed the market and helped create the country’s largest medical device manufacturer of oral appliances. Patients, dental providers, and physicians embraced better design, comfort, safety, and performance.
Because we’ve addressed how to meet payers needs with scientifically designed software and predictable reimbursement workflows, “not getting paid” and “the hassle of working with medical insurance” will no longer be excuses for giving up on DSM.
Joining Restfull powered by IAOS means more than just adopting cutting-edge software – it’s about reclaiming your ability to practice the dentistry you love with financial confidence. Restfull doesn’t just offer you a tool; it provides you with freedom – freedom from claim denials, cash flow uncertainty, and administrative overload. Coaching is even included in our basic package, because your success is our success.
I couldn’t be more excited for this new role, leading a team dedicated to member success. Dental sleep medicine, teaching at Pankey, consulting with practices, helping develop better devices, and now fitting the final puzzle piece – reimbursement – together, have all been deeply rewarding… both spiritually and financially. I am leading a blessed life.
Understanding and managing the medical reimbursement environment will align oral appliances for prompt and improved reimbursement.
Restfull Powered by IAOS: A Game-Changer in DSM
At Restfull, our guiding principle is that predictable, fast payments create sustainable, successful DSM practices. Our proprietary suite finally clears the hurdles that previously kept us from interfacing seamlessly with insurance providers. We reduce the pre-auth approval timeline, dramatically shorten the reimbursement cycle to under 30 days, and get claims paid at the full reimbursable rate.
Restfull ensures thorough, accurate claim submissions by prompting complete documentation through our software. Each necessary detail is captured precisely and designed to follow the exact compliant steps required – preventing denials due to incomplete information before they occur. This software-driven guidance is essential to helping more dentists experience financial success in dental sleep medicine.
But the power of Restfull goes beyond billing. We understand dentists’ daily challenges because Restfull was designed by sleep dentists, for sleep dentists, drawing from 12+ years of helping DSM providers through the IAOS.
We’ve streamlined every step – from telemedicine and automated patient communication to digital referral management – ensuring reduced chair time (often just 7–10 minutes) and an efficient, seamless workflow.
Get Paid for Doing What You Love
Ultimately, embracing technology like Restfull ensures dentists are fairly compensated for their vital work – positively impacting countless lives. As the proverb wisely says, “Give a man a fish, and you feed him for a day. Teach him to fish, and you feed him for a lifetime.” Restfull powered by IAOS equips dentists with the technological tools they need – not just to treat patients better, but to ensure predictable, reliable payments that allow their practices and professional satisfaction to flourish.