The Centers for Medicare and Medicaid Services (CMS) has taken a significant step forward in healthcare by recognizing the crucial connection between oral health and overall well-being. Specifically, CMS now acknowledges the impact of periodontal disease and its association with inflammatory conditions, including adverse pregnancy outcomes. This recognition marks a major advancement in the integration of dental care within broader medical treatment plans.

At Dental Classrrom], we understand how these changes will reshape the landscape of dental care and claims processing. In this blog, we’ll explore what this means for providers and patients, as well as how the new CMS dental claims system—live as of July 1, 2024—will streamline the submission and processing of electronic 837D dental claims.

The Oral Health and Systemic Health Connection

Periodontal disease, commonly known as gum disease, has long been a concern for dental professionals. However, more recent research has shown that it is much more than a localized issue. Periodontal disease has been linked to inflammatory comorbidities such as cardiovascular disease, diabetes, and rheumatoid arthritis. Perhaps most notably, poor oral health, including periodontal disease, has been associated with adverse pregnancy outcomes such as preterm birth and low birth weight.

CMS’s recognition of this connection is an important step in improving healthcare outcomes, as it emphasizes that oral health is not isolated from overall health. The integration of dental services into medical care is not only logical, but it is also essential for delivering comprehensive care that addresses the root causes of many systemic health issues.

CMS Launches New Dental Claims Processing System

In response to the growing recognition of the role of oral health in systemic diseases, CMS launched its new dental claims processing system on July 1, 2024. This system allows for the submission of electronic 837D dental claims, enabling providers to more easily submit claims for services that are linked to broader medical conditions. The new system is designed to improve efficiency, reduce paperwork, and expedite claims processing for dental services associated with conditions such as head and neck cancer, chemotherapy, and more.

The ability to submit electronic dental claims is a significant advancement for dental practices, allowing them to focus more on patient care and less on administrative burdens. For patients, this means a more seamless healthcare experience, where necessary dental services are fully integrated into their treatment plans.

What the CY 2024 Medicare Physician Fee Schedule Means for Dental Providers

CMS has also expanded its efforts in integrating dental care with the finalization of the CY 2024 Medicare Physician Fee Schedule (PFS) Final Rule 88 FR 78818. This rule outlines specific policies that allow for the payment of dental services that are linked to medical treatments. According to CMS:

“For CY 2024, we are building upon our efforts in the CY 24 PFS final rule and are finalizing:

1. A codification of the previously finalized payment policy for dental services for head and neck cancer treatments, whether primary or metastatic.
2. The codification to permit Medicare Part A and Part B payment for dental or oral examination performed as part of a comprehensive workup prior to medically necessary diagnostic and treatment services, to eliminate an oral or dental infection prior to, or contemporaneously with, those treatment services, and to address dental or oral complications after radiation, chemotherapy, and/or surgery when used in the treatment of head and neck cancer.
3. Our proposal to permit payment for certain dental services inextricably linked to other covered services used to treat cancer prior to, or during:
1. Chemotherapy services.
2. Chimeric Antigen Receptor T- (CAR-T) Cell therapy.
3. The use of high-dose bone modifying agents (antiresorptive therapy).

These changes mean that dental services, which were previously considered separate from medical treatments, are now fully integrated with care for patients undergoing treatments for serious conditions such as cancer. This is a huge step forward for both dental providers and their patients, as it enables better overall health outcomes through comprehensive care.

Implications for Dental Providers and Patients

For dental providers, the CMS dental claims processing system and new policies within the Medicare Physician Fee Schedule present a major opportunity. Dental practices can now be reimbursed for services that are directly tied to larger medical treatments, particularly in cases where oral health is critical for preventing complications before, during, or after cancer treatment.

For patients, these changes mean improved access to dental services that are crucial for their overall health. Oral examinations, infection control, and dental treatments that were once considered elective or separate from medical care can now be covered as part of a broader treatment plan. This integration ensures that patients receive the care they need to prevent complications and improve outcomes, particularly when facing serious health challenges such as cancer or other inflammatory conditions.

Conclusion: The Future of Dental and Medical Integration

As CMS continues to prioritize the integration of oral health into broader medical care, the future looks bright for both providers and patients. The launch of the CMS dental claims processing system and the updates in the CY 2024 Medicare Physician Fee Schedule signal a new era where dental services are recognized for their critical role in maintaining overall health.

At Dental Classroom, we are excited to help dental practices navigate these changes and ensure that they are fully equipped to submit and process claims under the new CMS guidelines. If you’re a dental provider looking for assistance in handling your claims, or if you want to learn more about how these changes impact your practice, don’t hesitate to reach out to our team of experts.

The intersection of dental and medical care is more important than ever, and we’re here to support you every step of the way.