ORIGIN OF TELEDENTISTRY
Teledentistry, a subset of telehealth[1], was introduced in 1994 by the DOD, Department of Defense, as
WHICH TYPE OF TELEDENTISTRY
Practically scarce until 2020, Teledentistry became an important tool in spite of its specificity. Seeing the patient real time on a computer screen speaking with you is certainly a better option than losing the visual on a phone. This gives us more information about the patient, at the same time realizing that this is not a replacement for an in-person physical exam, but our best alternative. This is also true with pier to pier collaboration with other providers, and is generally not readily utilized prior to the quarantine during this coronavirus pandemic. Due to the nature of its function, remote access is required with real time or asynchronous/cloud-based Teledentistry which stores and then subsequently sends the message. Cloud based data is most often times laboratory, radiology or other testing results.
TELEHEALTH LEGISLATION, FEDERAL
An Executive Order On Aug. 4 directing Health and Human Services,(HHS) to review and continue Medicare’s coverage of telehealth services. The order also allows telehealth providers to offer new services following the COVID-19 pandemic, provided such services are authorized by state governments. Finally, the order seeks to expand broadband access – and thus telehealth services – to rural areas by providing additional funding and flexibilities to foster access to care.[3]
Up until the pandemic, strict HIPAA guidelines required specific security measures to utilize software and messaging programs. In March, the Department of Health and Human Services (HHS) was directed by the President to lift several rules during the pandemic of 2020:
1. Originating site requirement. Suspended, patients can receive services from where they live.
2. No HIPAA penalties for clinicians during the good-faith provision of telehealth.
3. HHS will not be conducting audits to confirm that telehealth patients have an established relationship with the clinician.
Additional telehealth legislation regarding Medicare reimbursement recently passed, which included 49 individual states and New York with licensure requirements. It says:
· Doctors engaging in telemedicine are licensed in the state in which the patient is located.
· All states and District of Columbia offer reimbursement for some form of live video with Medicaid fee-for-service.
TELEDENTISTRY SOFTWARE
Until this, Teledentistry and telemedicine were something we experienced on the Carousel of Progress audio-animatronic stage show in Walt Disney World. The likely reason it never became a popular forum until this year is because the nature of dentistry relies on an intimate experience which by its very nature violates one’s personal space, and requires contact. Therefore, the environment and operation of a remote system is counterintuitive to operate and examine and treat a patient under the premise of a distant interaction. With this in mind many may question the role this approach takes within the career of dentistry.
Key Features:
· Messaging feature that includes the patient and providers.
· Simple Live Video
· Intuitive functions for patients and users.
· Visual shareable treatment plans
· Secure end to end HIPAA compliant atmosphere.
· Easy workflow shifts between different patients and providers
· Consolidated record of communications with archivable recordings.
· Comprehensive documentation capabilities.
· Seamless collaboration and sharing among providers and patients.
· Easy workflow mapping.
· Seamless workflow and integration within a practice including prescription services without the need to rework current practice management programs.
Here are a few software vendor names to include from a recent web search of “popular dental software programs”. I cannot attest to any of their features or any information about their operation except for one practice management software company I have used for 26 years. Probably the longest lasting vendor business relationship I’ve had. We have had ups and downs with this company, but I remained with them. An important investment will be in the practice management system you purchase. It is the heart of your practice and requires careful thought and consideration before making a decision on a software practice management investment.
· Eaglesoft
· Open Dental
· Carestream
· Denticon
· Curve Dental
· DentiMax
· AxiUm
· Dental Intelligence
APPLICATIONS IN DENTISTRY
As an Oral & maxillofacial surgeon I can see the benefit for using this tool specifically within our specialty. Emergent head and neck trauma or serious infections of those in rural areas where trauma surgeons and specialists may not be readily available 24/7, this kind of technology can be of assistance to remedy access to care issues.
Obtaining specialty opinion on the spot when it would otherwise take a significant amount of time before a provider is available.
Patients with significant chronic systemic diseases that require collaboration with the patient’s physician such as a transplant or a dialysis patient, cardiopulmonary disease requiring ongoing therapy and supplemental oxygen. Poorly controlled diabetics, immunosuppression due to a chronic illness or secondary to medicinal therapies. Additionally, those individuals with a complex dental treatment plan requiring multispecialty care; such as a patient requiring multiple extractions, endodontic care, and full arch restorations. Providers can virtually be in the same room to discuss and examine a patient and radiology and laboratory studies. This type of collaboration can help to expedite care and treatment and prevent delays due to the need for a patient to visit multiple providers which prolongs the process. The best use of this technology is in remote rural areas where patients may be a long distance from providers. This can at least allow some guidance to help a patient determine what specialist they may need to consult.
TELEDENTISTRY PROCEDURE CODES
· D9995 Teledentistry-Synchronous; real-time encounter.
· D9996 Teledentistry-Asynchronous; information stored and forward to the dentist for subsequent review.
These codes define the nature of the encounter and are utilized in conjunction with the appropriate examination code(s).
SECURITY
In order for patient data to be protected from hackers it must be encrypted. Understanding that this means the message is written in a separate code or language that transcribes the message and requires a “key” to translate the message to our language or an access code we receive on our device. Also known as Two-factor Authentication.
An internet connection with sufficient bandwidth that will allow video streaming. Also, basic minimum requirements for optimum security would include:
1. Device (Bluetooth/Wi-Fi) Security
· Networked personal device, i.e. Fitbit.
· Wearable external device, i.e. insulin pump.
· Implanted device internally, i.e. pacemaker.
· Stationary device, cardiopulmonary patient monitor or chemotherapy dispenser.
2. Access Security
3. Patient identification
4. Provider identification
https://www.whitehouse.gov/presidential-actions/executive-order-improving-rural-health-telehealth-access/
THIRD PARTY, INSURANCE COVERAGE
Some dental third-party payers have decided to document the policies related to Teledentistry and insurance benefits.
· Delta Dental: Under Delta Dental policy, the fees for Teledentistry (D9995 and D9996) are considered inclusive in overall patient management and are not billable to the patient. Standard dental policy will apply to the evaluation codes.[4]
· UnitedHealthcare Dental will waive frequency limits and any benefit provided for the below services will NOT count towards the patient’s annual maximum benefit, if any, for dates of service prior to September30, 2020 when submitted in accordance with applicable Federal and state regulations. UnitedHealthcare Dental will continue to evaluate and update this guidance as appropriate. [5]
· Most Cigna Dental Care dental plans provide coverage for a combined total of up two D9995s and/or D9996s (two D9995s; or two D9996s; or one of each), per calendar year. D9995 or D9996 are not covered unless reported in conjunction with one or more other dental procedures that are covered by the dental plan. [6]
[2] https://www.dentistryiq.com/dental-hygiene/clinical-hygiene/article/16367765/teledentistry-an-exciting-new-tool-in-our-arsenal
[3] https://www.whitehouse.gov/presidential-actions/executive-order-improving-rural-health-telehealth-access/
[4] https://www1.deltadentalins.com/newsroom/releases/2020/03/important-information-for-our-providers-about-teledentistry.html
[5] Uhcdental.com
[6] https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/dental/OralSurgeonRefGuide.pdf
Comments