advance your dental practice and improve patient outcomes

Unlocking New Opportunities: Advance Your Practice and Improve Patient Outcomes

Written by: Scott S. De Rossi, DMD, MBAScott S. De Rossi, DMD, MBA

For decades, Medicare has offered minimal coverage for dental care, leaving millions of seniors to face the financial burden of maintaining their oral health. This gap has significant implications, as poor oral health exacerbates chronic conditions like diabetes and cardiovascular disease. However, recent regulatory changes are signaling a shift in Medicare’s approach to dental coverage. These updates not only represent progress in integrating oral and systemic health but also offer opportunities for dentists to advance their practice, improve health outcomes, and expand access to care.

A Changing Landscape

Medicare’s 2023 and 2024 Physician Fee Schedule Final Rules introduced new guidelines for dental services that are deemed “medically necessary.” While Medicare’s exclusion of dental services was once nearly absolute, these updates now allow coverage for oral examinations and treatments in specific medical scenarios, such as:

  • Prior to organ transplants or cardiac valve replacements
  • For patients undergoing cancer treatments, including chemotherapy and CAR-T cell therapy
  • For managing complications arising from radiation or high-dose cancer therapies

Although this expansion is limited, it represents a critical acknowledgment: oral health is integral to overall health.

The Growing Need for Integrated Care

According to Pew Research Center (January 2024), the 65+ population in the U.S. currently stands at 62 million and is projected to reach 84 million by 2054. This growing demographic is maintaining their natural teeth longer while dealing with more comorbidities, placing new demands on oral healthcare providers. The integration of dental and medical services is no longer a fringe concept—it is becoming a necessity. Medicare’s recent policy changes encourage a more collaborative approach, recognizing the critical role dental professionals play in the continuum of care.

How Dentists Can Take Advantage of Medical Billing

For dentists, these regulatory changes are not just a shift in policy but an opportunity to enhance their practice in several ways:

  • Expand Patient Services By integrating medical billing into their practices, dentists can offer services previously inaccessible to patients under Medicare. This includes medically necessary dental care tied to major surgeries or treatments for life-threatening conditions.
  • Improve Health Outcomes Addressing oral health issues as part of broader medical treatment plans can significantly enhance patient outcomes. For example, managing oral infections before cancer treatments can reduce complications, improve treatment efficacy, and speed recovery.
  • Strengthen Practice Viability Leveraging medical billing allows practices to diversify revenue streams and better serve patients with complex medical needs. It positions dental practices as essential components of the healthcare system.
  • Lead the Charge in Oral-Medical Integration Dentists who embrace medical billing and integrated care can position themselves as leaders in the shift toward whole-person health. By working collaboratively with medical professionals, they can drive systemic changes that benefit patients and elevate the profession.

Navigating the Challenges

It’s important to note that while these updates are promising, they are not without limitations. Medicare’s expanded dental coverage remains tightly linked to specific medical conditions, leaving routine dental care largely excluded. Advocacy for broader reforms is essential to ensure more comprehensive benefits in the future.

For dentists looking to navigate the complexities of medical billing, solutions like Nexus Bill offer turnkey options for implementing medically necessary dental care.

The Road Ahead

The recent Medicare changes reflect a growing recognition of the connection between oral and systemic health. However, the responsibility lies with oral health professionals to seize these opportunities and push for further reforms. By embracing medical billing, expanding access to care, and fostering collaboration with medical colleagues, dentists can transform their practices and the lives of their patients.

The time for action is now. As oral health professionals, it’s our duty to lead the way in integrating oral health into the broader healthcare landscape. After all, our patients’ overall health depends on it—and they’ve waited long enough.

Be the change. Embrace the shift. Transform oral health.

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