Someone owns the return leg
Dental clearance takes 22 days at the median. Adjuvant radiation should start within six weeks of surgery. ReferralRight holds the clock so the report lands before it runs out.
The arithmetic
That is the whole problem, and nothing in it is anyone's fault. Twenty eight plus fourteen is forty two. The window closes exactly as the clearance arrives, so any single missed fax spends time the patient does not have.
Clearance timing figures are from a single center retrospective review of 356 head and neck patients at a Canadian tertiary center. Median 22 days from surgery to clearance, range 8 to 119. Median 28 days from consultation to radiation clearance. Roughly 60 percent of patients experienced a radiation treatment delay. Single center, and we label it as such.
What is actually missing
Not the referral. Referrals go out every day, and the physician side has a form. What is missing is the answer coming back, and the reason it is missing is that nobody ever defined it.
The exchange the payment rule contemplates has two legs. The first leg is a request. Only the pair is an exchange, and the second leg has no format, no addressee of record and no clock. So it arrives by fax into a tray, or it does not arrive, and both look identical from the coordinator's desk.
ReferralRight is one record with two signed legs and a deadline derived from the date that actually matters: the proposed medical procedure. Either side can start it. Whoever answers second closes it.
How it works
- Send it through whatever already reaches them. Email or fax. The dental office does not have to install anything, sign up for anything, or be on your hospital's system.
- They answer on a link. No account, no password, no software. They confirm the patient's date of birth, then file findings, treatment, and a disposition of cleared, not cleared, or cleared with conditions.
- Both sides hold the signed record. The clock is visible the whole time, and the completed pair exports as a PDF for the chart.
Nobody has to adopt this. A dental office that receives one referral and answers it has used the entire product, and a coordinator who never signs up can still be the one who gets an answer back.
You can start this by yourself
One person can run this for one patient this afternoon. Nothing to install, nothing to sign, nobody else who has to agree first. You do not need your hospital's system to change, you do not need the dental office to join anything, and you do not need a budget, because there is nothing to buy.
Start with the next case on your desk. After a few loops you will have something you did not have before: the number. How many went out, how many came back signed, how many days it took, and how many are still open past the date the mouth had to be ready. Those numbers are yours. Keep them, print them, take them to whoever asks you how referrals are going.
Most people find that easier than explaining it in advance.
For dental offices
The bottleneck on these cases is not willingness, it is enrollment. About 2.4 percent of dentists are enrolled in Medicare, so for most practices the linked dental lane is not a thing they declined, it is a thing nobody told them existed.
Answering a ReferralRight referral costs nothing and requires no account. When you file the report, the record carries the one operational detail most often missed: the referring physician's name and Medicare PIN belong in Box 35 Remarks of the 2024 ADA Dental Claim Form or the 837D.
Referring the other way
The same record works when the question runs from your chair outward: you have found something and you want a physician's opinion before you treat. Send it the same way, and the answer comes back to you without anyone creating an account.
You will know it arrived, you will know when it was opened, and you will not have to phone anyone to find out.
Refer a patient for medical review
What this costs
Nothing, for everyone on the loop, permanently. Not a trial, not a pilot, and not a free tier of a paid product. A coordination record that some participants cannot afford to open is not a coordination record, and excluding qualified participants from a referral arrangement is its own legal problem.
Start a referralRefer for medical review
Why this record exists. Medicare payment for dental services that are inextricably linked to a covered medical service depends on a documented exchange of information between the treating physician and the dentist (CY2023 Physician Fee Schedule preamble, 87 FR 69673). The KX modifier attests that the linkage requirements are met. Per CR 13649 contractors may deny claims submitted without it for claims received on or after January 1, 2025, and the modifier is mandatory for claims received on or after July 1, 2025.
CMS published no instrument for this exchange. The ADA publishes a one way sample referral form whose return leg is a single checkbox reading "Written or Faxed Report from Dental Office / None," with no defined format. No CMS, ADA, HL7, X12 or specialty society standard defines what the dentist sends back. That undefined return leg is what this builds.
ReferralRight is not a CMS instrument and not a claim. It documents coordination. It does not determine coverage, submit a claim, or replace clinical judgment. The dentist must be enrolled in Medicare before providing the linked dental service.
ReferralRight is free to every party on the loop: coordinators, physicians and dentists. There is no paid tier of this record and no participant is excluded.