COVID may have kicked teledentistry into high gear, but demand for it was already growing and it isn’t going anywhere anytime soon. Below, we’ll explore some of the most common concerns dentists have when getting started with teledentistry, including technology, cost, and patient privacy, plus outline the steps involved in a successful launch. It’s an ideal starting point if you’re exploring whether telehealth is right for your dental practice or if you’re ready to get started and looking for an implementation roadmap.
You can read this guide in its entirety or jump to the steps you want to learn about.
- Step 1: Familiarize Yourself with the Basics of Teledentistry
- Step 2: Check Your State Guidelines
- Step 3: Check Your Malpractice Insurance
- Step 4: Choose Your Teledentistry Software Wiseley
- Step 5: Establish Billing Procedures
- Step 6: Map Out Your Workflow
- Step 7: Educate Your Team
- Step 8: Create a Video-Friendly Space
- Step 9: Promote It
- Step 10: Don’t Limit Yourself
Step 1: Familiarize Yourself with the Basics of Teledentistry
Before beginning the instructions, it’s important to get on the same page about teledentistry; what it is and how it works.
There Are Several “Types” of Teledentistry
Teledentistry isn’t a standalone service. It’s a delivery method of patient care, or, in the words of the American Dental Association (ADA) it “provides the means for a patient to receive services.” There are a few different types. Knowing the difference is essential for billing and selecting the right model for your practice.
Synchronous teledentistry can also be described as “real-time” or “live” teledentistry. These days, video conferences are what comes to mind for most people, but phone calls are another low-tech form. For the most part, we’ll be focusing on synchronous teledentistry on this page.
Asynchronous teledentistry is also known as “store-and-forward” teledentistry. In these cases, you’re not communicating in real-time. You might be engaging with a patient via email or if you’re collaborating with another dentist through a referral system like Medcohere and evaluating x-rays you’ve been sent.
Remote Patient Monitoring
With remote patient monitoring (RPM) data is sent electronically from an individual to a provider in another location for use in care or in support of care. For example, you might receive regular reports on a patient’s saliva pH levels or receive information on how a patient is responding to their sleep apnea device.
There’s some debate around mobile health (mHealth) and what it entails. The ADA lumps it in with teledentistry and defines it as “Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and personal digital assistants (PDA).” The World Health Organization (WHO) largely agrees. However, some sources limit this area to self-help or self-care tools. A phone app that sends a patient reminders to floss would be a form of mHealth under either definition. However, if a patient is taking samples of their saliva and uploading them to an app, as was the case with the remote patient monitoring example, the same might also be considered mHealth by its broader definition.
Teledentistry is Clinically Sound
Research shows both dentists and hygienists can diagnose with an incredibly high degree of accuracy using something as basic as a smartphone.
Oral Cancer Diagnosis: In one study, dentists viewed smartphone images alone and caught more than 70% of malignant lesions with no false positives. The study was released in 2016 and included cameras that started at just five megapixels. (We can’t be too hard on them. It was the era of the iPhone 5 and 6!)
Traumatized Teeth: A 2017 study looked into the diagnosis of traumatized teeth. When the dentists were given a photo and clinical data, they nailed the diagnosis 93% of the time.
Diagnosis of Cavities: Another 2017 study evaluated the ability to diagnose caries. There was no difference at all in the accuracy of diagnosis from in-person visits versus viewing photos for dentists or hygienists.
Patient Demand Remains High
Research from McKinsey shows just 11% of Americans were using telehealth services before COVID. By May 2020, about half the population was leveraging it. The shift was even more remarkable among certain demographics. For example, Medicaid reported a 2,500% increase in telehealth services for children.
It might be easy to think this is a passing phase that will depart as the virus does, but this trend began before COVID arrived. A 2019 Dentavox survey showed 78% of patients thought they’d be using teledentistry services within the next couple of years. A look at Google Trends also shows that, while consumer interest in the term “teledentist” spiked at the onset of COVID, it hasn’t been dropping during periods of lower infection rates like other terms have. Furthermore, a recent consumer survey shows 97% of patients are satisfied with their telehealth visits.
In other words, COVID may have accelerated the growth in teledentistry, but demand was already booming and patients, now comfortable with it, will expect it going forward.
Step 2: Check Your State Guidelines
Each state has different teledentistry laws. It’s not really a case of whether your state allows teledentistry or not, but under what circumstances it’s allowed and what procedures you’re allowed to perform. For example, Pennsylvania presently has no teledentistry guidelines and 42% of dentists there are using teledentistry according to DentaQuest research. Meanwhile, states like Texas also have no teledentistry guidelines, but general laws require a “tactile and visual examination” be performed and documented. This limits teledentistry options considerably and may be why the state has respectively low adoption of teledentistry.
Research from the American Academy of General Dentistry (AAG) concludes that 23 states outline teledentistry regulation and reimbursement guidelines, but the landscape is rapidly changing. With that in mind, it’s important to confirm which laws may impact you before you begin providing services.
Step 3: Check Your Malpractice Insurance
Generally speaking, insurance companies used the inclusion of teledentistry in their malpractice policies as a major selling point when the pandemic began, so chances are you will be covered for teledentistry under your current policy. However, some insurance companies sell it as an add-on or separate service, so be sure to contact your insurance company to make sure you’ve got the level of coverage you need.
Step 4: Choose Your Teledentistry Software Wiseley
Choosing the right teledentistry software ensures your launch goes well and will impact both usability and profitability going forward. We’ll explore a few considerations below.
Look for HIPAA-Compliant Teledentistry Software
Under ordinary circumstances, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) precludes the use of most off-the-shelf video conferencing software for privacy reasons. However, the Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) temporarily gave a green light to non-compliance for the duration of the “COVID-19 national emergency.”
More than 40% of dentists providing telehealth services took advantage of the relaxed guidelines during the pandemic, according to Dentalquest data. However, it’s unclear how much longer the national emergency will be extended, so it’s a good idea to migrate to a HIPAA-complaint option if you’re already providing teledental services. You’ll want to begin with one if you’re planning to launch now too.
Choose Software That Integrates with Your Practice Management Software
Opt for an integrated solution if one is available for your software. For example, pwTeledentist creates a seamless experience and streamlined workflows for Practice-Web users.
Naturally, you’ll need a digital method for collecting health histories and other essential patient forms. However, it’s worth noting that some states have requirements that you obtain a consent form that specifically relates to teledentistry. This is the case for California dentists.
Practice-Web makes this easy! If you have an active Support agreement, you’ll have access to paperless/ online forms, which you can use as-is, customize, or create from scratch. These can be sent to patients via email or text message, alone or in packets, and can be effortlessly imported into your software once completed by the patient.
While you can piecemeal reminders for virtual appointments together by mixing platforms, it’s not always easy to ensure everyone gets their reminders and verify confirmation status when you’re using multiple third-party applications.
This is another area where Practice-Web shines. With pwTeledentist, you can schedule your teledentistry patients alongside your patients visiting in person within the Appointments module. That way. They’ll fall into your practice’s natural workflow, whatever that may be. For example, if you’re using pwConnect, our mass text message and automated text reminder service, your teledentistry patients are reminded of their appointments at intervals of your choosing, and their confirmation acknowledgments are automatically recorded.
An integrated program makes keeping accurate records a breeze, as you’ll already be using a program that handles your charting for you.
With Practice-Web, you’ll already have records of each procedure included in the appointment because you’ll be using the integrated schedule. You can also take advantage of time-saving features like Auto Notes that allow you to create detailed chart entries in just a few clicks—no need to hand key all your notes!
By using a fully integrated Teledentistry system, billing falls within your natural workflows too. The codes are already there, and claims can be instantly sent.
Practice-Web allows you to choose just about any clearinghouse you like. You can use our eClaims and Eligibility service to send digital claims and get paid digitally too, dramatically speeding up the payment process and improving practice cash flow.
We also have tools like Pay-by-Text that let patients pay their portion digitally, send you instant payment, and automatically records the payment in the Account module, so you get paid faster and are freed from unnecessary manual processes.
Make Sure Your Teledentistry Software Archives the Video
Especially as you move into video conferencing designed for the consumer market, you may not be able to record and archive the video for later viewing. The ability to archive videos is a huge component of accurate recordkeeping and can assist you if you delay adding your chart notes until sometime after the visit concludes.
With pwTeledentist, your video archive will automatically appear in the patient’s chart after a brief processing time when your session concludes, so you can easily access it for whatever reason at any point down the road.
Find Out If You’ll Need Additional Tech to Operate
Sometimes programs require additional hardware, such as cameras or computers, which can dramatically increase your startup costs and create unnecessary headaches.
pwTeledentist is designed to work with what you already have—on any device and with just about any camera—so there’s no need to purchase anything extra.
Choose a Program That’s Mobile-Friendly
It’s important that your teledentistry software works well on all devices, including desktop computers and mobile phones. In many cases, cell phones are the only way your patients will have access to a video camera, and they may be their preferred method regardless. However, be wary of selecting a program that only uses a mobile app. That can make it harder for you if you’re seeing patients remotely from your office and may make it harder (or impossible) for some of your patients to attend teledentistry sessions.
pwTeledentist leverages Practice-Web’s Dentist and Patient Portals, plus offers the option to launch video directly from the patient’s chart within Practice-Web. This ensures you’re using a HIPAA-compliant communication method, both you and the patient can log in using any device, and you won’t need to purchase any special software or do additional downloads to have a session.
Keep an Eye on Pricing
Teledentistry software can be expensive and may come with hidden costs. As you evaluate each one, make sure you’re calculating the base price and unusual fees, such as charges for extra users, video storage, additional patients, or a fee each time you host a video session. Some will also slip in unnecessary services, forcing you to pay more for products you don’t need.
Suffice it to say, pwTeledentist costs about half as much as other teledentistry software and there are NO hidden fees. You can also purchase it alone or stack it with other services for an end-to-end digital solution.
Step 5: Establish Billing Procedures
While much of your billing process can stay the same, especially if you’re using an integrated teledentistry software, there are a few things to pay special attention to.
CDT Teledentistry Billing Codes
First and foremost, it’s important to note that you aren’t required to charge any kind of additional fee for a teledentistry visit, but you have the option to do so and may feel it’s warranted if you’re paying additional costs to provide treatment. However, you’ll need to use the correct billing codes to demonstrate that the patient was not with you for the visit. Teledentistry billing codes were added in 2018. As the ADA states, these include:
D9995 teledentistry – synchronous; real-time encounter Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
D9996 teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
Common Procedures Billed Alongside Teledentistry
As a reminder, teledentistry is not a procedure by itself. It’s a mode of delivery. With that in mind, you’ll want to bill for any applicable treatment performed during your teledentistry appointment. Per the ADA, common examples include:
D0140 Limited oral evaluation – problem focused; An evaluation limited to a specific oral health problem or complaint. This may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately. Definitive procedures may be required on the same date as the evaluation.
D0170 re-evaluation – limited, problem focused (established patient; not post-operative visit) Assessing the status of a previously existing condition. For example:
- a traumatic injury where no treatment was rendered but patient needs follow-up monitoring;
- evaluation for undiagnosed continuing pain;
- soft tissue lesion requiring follow-up evaluation.
D0171 re-evaluation – post-operative office visit
D9992 dental case management – care coordination; Assisting in a patient’s decisions regarding the coordination of oral health care services across multiple providers, provider types, specialty areas of treatment, health care settings, health care organizations and payment systems. This is the additional time and resources expended to provide experience or expertise beyond that possessed by the patient.
It may go without saying, but just because you can bill an insurance company for a specific code doesn’t mean they’ll pay it. Plus, your patients may be responsible for some or all their other procedure fees. Decide in advance how you’ll handle any non-payment issues from insurance companies and traditional patient co-pays, or cash-pay patients. You can also use a service like eClaims and Eligibility mentioned earlier. It takes the guesswork out of estimates by providing you with real-time insurance benefit info. Consider pairing it with Pay-by-Text for instant virtual payments of patient portions too.
Step 6: Map Out Your Workflow
It’s helpful to map out the patient journey in advance, so you can look for any loopholes or other ways to digitize.
In a low-tech office, patients may only be able to connect with you via phone. In a connected automated practice, patients may have lots of ways to get in touch.
- Text message
- Social media
- Patient portal
Offices just starting their digital transformations are usually reliant on manual booking through a staff member. However, there is a multitude of options at your disposal. You can even have patients self-appoint!
- Staff member
- Online booking
- Digital referrals
Confirmations and reminders have historically been handled via postcards and phone calls. However, you may have lots of ways for patients to confirm today.
- Staff member
- Automated text message
- Automated email
If you’re trying to hodgepodge things together to make teledentistry work, you may be scanning forms, sending copies to patients to fill out by hand, and then hand keying the information on receipt. Thankfully, it’s easy to go digital and automate.
- Online forms
If you’re not using an integrated system, you may be wrestling with phone calls, email, and messaging apps to do teledentistry. There is, of course, a better option.
- Teledentistry software
If you’re low-tech, you’re probably handwriting notes or using word processors. You might also be transcribing notes for an assistant to complete later. This is another reason why it pays to use integrated teledentistry software.
- Your charting tools
- Archive of video
Most of the time, patients require some form of follow-up after their virtual appointment. While the list doesn’t vary dramatically in this respect whether you’re using an integrated solution or not, the integrated solution will fall within your natural workflows and let you save some trees.
- In-office care
- Digital referral
- ASAP list
We touched on billing a bit earlier, but it’s important to consider it as you map out what will happen during and after an ideal teledentistry session too. If you don’t address it ahead of time, you could be stuck waiting on payment.
- Statements mailed/ emailed
- Staff member via phone
Step 7: Educate Your Team
Before you officially launch your teledentistry services, it’s important to bring the team together to learn about your new processes. Because they’ll be the ones on the frontlines answering patient questions, it’s a good idea to arm them with information that can help ensure patients are comfortable with the process and what to expect too.
Depending on your leadership style, you can also invite the team into preliminary discussions, such as mapping out workflows and looking for potential kinks in the system. Because each person fulfills a different role in your practice, they’re likely to view the transition from a different angle.
It’s also worth noting that “teledentistry” is usually focused on dentists, but if you’re using a good program (especially one that isn’t charging you by the call), your team may find other uses for the technology. For example, your hygienists can use it to help with hygiene education and treatment coordinators can use it to present treatment plans remotely. This method is helpful in a multitude of situations, but it’s incredibly popular with practices that see children, as one parent can attend with the child and another can be brought in via video or watch the session at a later time.
Step 8: Create a Video-Friendly Space
If you’re hosting teledentistry sessions on the go from your mobile phone, you may have little control over your environment. However, most sessions are typically held in the office or at the dentist’s home. That means you have ample opportunity to create a professional image and control perceptions.
Clear the Clutter
Take time to stage a nice setting that feels relaxing. You can opt for a clinical setting or one with a homey feel, but take care to remove items that aren’t needed, especially paperwork and things that have sensitive data. And, as classy as bookshelves seem in the movies, they’re not great for video conference backgrounds… unless you don’t mind your patient looking over your shoulder and scanning the titles or your trinkets the whole time!
Make a Distraction-Free Zone
Patients will feel you’re tuned in to them and providing better care if there’s no background activity or noise. Creating a distraction-free zone for your teledentistry sessions also helps preemptively eliminate any concerns about patient privacy.
Establish Good Lighting
Natural lighting is a great option, provided the window is in front of you. Sitting with a window to your back might make a nice backdrop, but it can easily cause distractions. Plus, placing any light source behind you will turn you into a silhouette.
If you can’t use natural lighting, keep your light source to the front of your face. It’s even better if you can use LED lights as they tend to produce more video-friendly color temperature and they run cool—a major benefit if you’re worried about getting hot and sweating during your sessions.
Take a Step Back
It’s often said that people present better when they’re standing up. You may feel more energized, have better posture, and appear more confident if you go this route. In any case, experiment with how you look on camera. Be sure that you’re positioned far enough away from the camera that you’re not creating a distorted image or cutting part of your head off.
Step 9: Promote It
Earlier in this guide, we mentioned that, before COVID, 78% of patients wanted teledentistry. The number is likely much higher now. The catch—less than one-third of dentists are providing teledentistry services. That means it’s a huge opportunity to attract new patients and improve patient retention. In order to tap into these benefits, you’ll want to promote it.
Share on Your Website
Mention your teledentistry services throughout your website. Start by adding something about it to your homepage or even add a banner to the top of your website. You can also mention it on your “contact us” page anywhere you share info for new patients.
If possible, create a separate page on your site dedicated to teledentistry and blog about it too. Naturally, the information will be helpful to patients, but it can also help you appear in search engines when people are looking for a teledentist.
Add it to Your Phone Message
While you’ll want to keep the message people hear when they phone your practice brief, try to slip in a line about your new offerings if you can.
Mention it in Your Online Booking Portal
If you provide the option for patients to book online, mention that you offer both types of appointments. With Practice-Web’s online booking service, you can structure and name various appointment types to make it clear that you have multiple options.
Spread the Word via Social Media
Word to the wise: people don’t like being sold to often online. However, they may welcome a post or two about your new offerings. Beyond that, you can keep it educational and/ or light. For example, you can take a short video of yourself using your new teledentistry software and mention that you’re excited or provide general facts and info. Include appropriate hashtags to increase your reach.
Beyond that, you may want to experiment with changing out your cover photos to promote your teledentistry services. It’s also important to pay special attention to sites like Google My Business and Yelp. Both allow you to mention measures you’re taking to ensure health and safety during COVID, so mentioning virtual appointments will help you attract new patients. This technique is even better if you pair it with your online booking link—prospective patients will learn about you and schedule right away!
Inform Your Patients with a Text and Email Campaign
Because it’s far easier to retain a patient than it is to attract a new one, make sure you’re educating your current patients about your new offerings too. Again, this is a great opportunity to include your online booking link, so patients can self-appoint as needed. If you use Practice-Web, you can send out a mass text campaign in just a few clicks with pwConnect or run a professional-looking email campaign on the fly with pwNewsletter.
Consider a Press Release
Chances are, a large news agency isn’t going to see your press release and jump at the chance to share your story unless there are extenuating circumstances, like you live in a small town and you’re the first one to offer it or you operate in an area where it’s notoriously difficult to attain dental care. However, most press release publishers share your release across the net, which can increase the chances that you’ll be found by prospective patients.
Step 10: Don’t Limit Yourself
You may have come into the idea of teledentistry because you wanted to bridge the gap during COVID, but there are many ways to leverage teledentistry software. Research from DentaQuest shows:
- 72% of dentists use teledentistry to prescribe antibiotics or meds for pain. It’s an end-to-end solution that ensures compliance with DEA mandates that require the use of audio-visual means when providing a controlled substance and can work in tandem with your electronic prescribing program.
- 63% of dentists use it to triage patients to prioritize care.
- 52% use teledentistry to facilitate a referral.
- 48% use it to perform visual exams.
- 38% use it to perform COVID screenings prior to visits.
- 38% use teledentistry to evaluate risk for disease.
- 37% use it to provide oral hygiene instructions.
As you can see, once you get started with teledentistry, the care options and potential revenue streams expand exponentially!