Like a kid in a candy story, Doctors today have their choice of dental group “flavors”. You have DSOs (the “S” can be support or service, and there is an apparent difference), DPOs, Group Practices, PE backed, VC backed, or even privately held. The great equalizer is that they are all businesses at the end of the day. The only way they continue to operate is by bringing in enough money to cover their expenses, which allows them to invest in more staff, equipment, space, or additional offices. A DSO is a business, all businesses aim to be profitable through effective revenue cycle, thus all DSOs are revenue cycle companies. Revenue cycle management is challenging, but it doesn’t have to be thanks to technology. How is your DSO leveraging technology to improve your business?
Revenue Cycle Management for most DSOs is intertwined and has many feedback loops to previous steps. Offices must deal with both patient and insurance AR, but for this article, we’ll look specifically at insurance AR. For simplicity purposes insurance AR can be broken down into four steps: Verification and Submission, Posting, Claim Follow-up, and Claim Analysis. Each of these steps is laborious and time consuming. There has historically been a lag in the dental industry with adopting technology. However, in the last 5 years the growth of dental groups and DSOs who find themselves requiring efficiency and visibility at scale to be successful has been a driver of change. At the same time there has been an exit of RCM talent in dentistry post-Covid that has driven a boom in the desire and need for technology as a resource multiplier. There are several companies that offer solutions to each of these steps, and some solutions are more straightforward than others. The state of technology in the RCM space is just starting to get off the ground but anticipate big leaps in the coming years.
Insurance Verification/Eligibility of Benefits
The first step in the revenue cycle process is tedious, time consuming, and the data you’re trying to pull isn’t always accurate. The benefit verification process is crucial to effective treatment planning and delivery, as well as informing patients accurately on their payment responsibilities. You need strong processes in place to make sure you’re collecting patient balances before they leave the office because it becomes increasingly difficult to collect once they leave. The process to verify insurance and get a complete breakdown of benefits, for most offices, involves phone calls, faxes, or visiting payor portals. One of the most common solutions to this “people necessary” task is to outsource the work. A third-party company has entire teams dedicated to making these phone calls to insurance companies or getting the data from the payor portals. There are several companies that use technology to help automate these manual steps. Most allow you to set schedules, so you can get the verified patient eligibility and benefit levels a few days before they’re scheduled to come in. These technologies save time by eliminating the looking up of data or encountering miscommunication with an insurance agent. As mentioned before, the providers of this information is a current limiting factor, but it’s slowly getting better through layers of data.
In an ideal situation, you have successfully submitted your claim with all necessary attachments and correct codes. The next step in the payor AR revenue cycle is the posting and closing of claims. Now your office must go through the remittance process and make sure the insurance payment matches the check/EFT/VCC deposit that’s in your bank account. Once you’ve confirmed those numbers match, you then go back to your practice management system to match the potential bulk check portion to the specific claim it belongs to, post the payment, and close the claim. This process requires a lot of back and forth between multiple systems, and additional opportunities for accounting errors to occur. While there is technology available it is a young technology in dental and the automation of posting can become complicated with DSOs with factors like: how they set up their banking structure and legal entities which can lead to additional errors. It’s one of the reasons why there’s such a low adoption of EFTs in dentistry compared to medical. Once the technology can overcome these complexities it will be beneficial in the posting process.
Claim Follow Up
Oftentimes claims are denied or only partially paid because they might be missing supporting documentation, attachments, or codes might be inaccurate for treatment performed. It is even common for there to be a data issue causing denial, or inability of a payor to accept/process the claim on their end. The average office has a Clean Claim Rate of 60%, which are claims that are paid on the first submission without additional intervention from your team. That means that 40% of your total claims submitted need additional attention, which can be a significant amount of collections outstanding. This is revenue that cannot be ignored, so the claim follow up team is usually the largest, both in size and FTE cost for a DSO. These team members log into their PMS, print out an “aged AR report”, go line by line on that sheet to see which patients/claims are still outstanding. Then they have to manually go to each individual payor portal, type in name, date of birth, date of service to try and find the claim. Once they find the claim, they open it, download the EOB, and figure out why the claim was not paid out in full. They have done all the research just to figure out what’s going on, now they still have to go fix the claim data, add the additional x-ray, or attach the requested narrative and go resubmit that claim again. This time inefficiency compounds at scale when there is one person handling 5 offices. Technology, like that provided by InsideDesk, helps to automate the labor intensive and time-consuming part of this process. Team members working aging no longer have to spend time printing out aging reports, visiting nearly as many portals, or making as many phone calls to figure out the status of a claim. The automation of these tasks allows them to close claims faster, get paid sooner, and paid at 100% of what’s owed. While this technology has a proven foundation to be beneficial, it is quickly advancing to provide more data and deeper insight.
The final step in your RCM process should be to analyze your internal processes. The ideal progression is smooth and fast from accurately verifying benefits to cleanly submitting claims, getting claims processed, paid, and posted within a 10–14 day period. While this is a typical timeline for “clean claims”, there are numerous opportunities in this process for things to stall or derail completely. It’s not enough for DSOs to only understand what has happened, but what is currently happening? The reality is it’s extremely difficult to know this today. The data is housed in 2-3 different places, which means pulling in multiple data sources, attempting to centralize, standardize, and manipulate to be able to process through a pivot table. There isn’t an easy way to quickly understand why your claims are being denied, at which offices, for which specific payors. InsideDesk’s analytics provide multiple data connections, which provides a streamlined way of centralizing and presenting actionable data to senior leaders.
The process of getting paid by insurance is simple, but it’s not easy. DSOs are realizing the necessity of technology, as a resource multiplier, as a key part of their RCM solution. They’re starting to understand not only the importance of RCM as a core function, but also that many of the traditional tools don’t provide what they need as they continue to scale. As RCM continues to be an important focus for DSOs looking to scale, the conversations also will evolve into deeper partnerships between dental groups and tech companies to provide the highest value products with scalable functionality.