Revenue Cycle Management for DSOs

1. RevenueCycleManagementforDSOs AsyourDSO grows, sodoesthe complexity ofyourbusiness. Keepingtabs onevery patient appointment, insurance provider, andpaymenttype getsmore andmore complicatedthe more patients you treat. That’s where revenue cycle management for DSOs comes in. We workwithDSOstofine tune RCMasthey scale. Whatisdental revenuecyclemanagement? Revenue cycle management(RCM)ishowhealthcare organizations likeDSOscollect revenue, startingwiththe patient’sfirstappointmentandendingwhen insurance claims and patient payments are complete. In other words, it links the provider with patient benefitsandpayorreimbursements. ThemainstepsofdentalRCM include:

2. Contracting andcredentialing:Establishingthe contract forprocedure • reimbursements or renegotiating them every 36 months or so. Credentialing is the application for registration to sign a doctor up to the reimbursement contract. On a 24-36monthbasis,youcan renewthis toassure providerlicensure andmalpractice • insurancearecurrent and in good standing. • Patientbenefits verification:Takingtheinfothe officehascollected fromthe patientandresearchingwhat benefitsthey actually have aspart oftheirinsurance plan. It’s important to do this before the appointment so an accurate treatment plan—and financial estimates—can be provided. This increases case acceptance from patients and provides clarity to the office how they can bill the payor while minimizingpatientfrustrations. • Claims processing:Submittingaclaimtothepatient’s insurancecompanyusing thecorrect servicecodes. • Reimbursement andcashposting:Receivingreimbursementfromtheinsurance • company andcollectinganyoutstandingpaymentfromthe patientforservices provided. • Claimsfollow-up:Followinguponoutstandingclaims(orpatientbalances)that • are unpaid. If not conducted properly, this can lead to serious cash flow issues, especially when the businessis dependenton afewmaininsurance payorsforallits revenue.Theprocessrequiresaclaimsspecialisttocalland/orusean onlineportal • toreviewunpaidclaims. They’llsupplyanymissingdatatoget the claimtobepaid,

3. or“appeal”the claimtobe reconsideredforpaymentwhen not paidorunderpaid fromwhatwasexpected inthe reimbursementcontract. Eachstephelpswork towardreceivingthehighestpossible reimbursementamount.The RCMprocessalsohelpsensurethataccountsreceivableismanagedappropriately. HowdoesRCM impactaDSO’sbottomline? Well-functioningRCMshouldaddresseachof thestepsabove. When donecorrectly,this financialprocesscan helpyourpractice keeptabson everyappointment,everyservice, and everyoutstandingclaimtomake sure everythingmakesitswaytoaccountsreceivable. The successof RCMcanbe measuredinthe totalnumberandvalue of outstandinginsurance claimsandpatientbalances. If any of the steps fall behind, it can lead to increasing unpaid claims—and ultimately, a cash flow issue for the DSO. If providers are paid on collections, they might be unhappy without commensuratecompensation. Thiscan leadtoturnoverorwrite-offs. But when RCM functions well, accounts receivable is minimized. Providers’ work is reimbursed in atimely mannerin accordance withthepayorcontracts.AndtheDSO’s bottomlineshouldstayin theblack. 5 tips for improving RCM inyourpractice If yourDSOwouldbenefit fromanimprovedRCMprocess, herearesometipstoconsider: UpdateUCR (usual,customary,andreasonable)ratesandpayorfee schedulesonanannualbasis.Confirm contractingandcredentialingfor eachprovider. Assureclaimsareverifiedandbatchedonadailybasis. Understand that each payor has a typical timeframe of remitting payment. Chart this for each payor and use it to follow up on claims that take longer thanexpected.

4. To improveyour RCMandinsuranceaccountsreceivable,beginwithwhat claimsmaytimeoutofpayorconsiderationbylargestdollaramount. • Whentacklinganoutstanding claimsissue,measuretheissueintermsof • accountsreceivableaswellasnumberofclaimsineach bucket.Accounts receivableissuesaresolvedbyaddressingeachclaim,so setrealisticgoals forhowmanycanbeaddressedeachdayorweekperperson. • Considerhiringoutsidehelp.Asyou grow,it’spossibletooutsourcesome of theRCM gruntwork.WerecommendcompanieslikeInside • Desk,Zentist,andMedusind. • DentalRCMconsultingwithSkytale • Revenue cycle management for DSOs is a complex process that many practices struggle to findeffectivesolutions for.That’swhyourDSOconsultantswork withclients toimprove theRCMprocess.It’sagreat waytohelp DSOsimprovetheircashflowandaccounts receivable. • Here’showSkytalehelpsDSOsdevelop oroptimizetheirRCM: • Assess:Reviewexistingbillingandcollectionpoliciesto identifyareascausingrisk tothe promptreimbursementfromcontractedpayors. Provide recommendations on outstandingpayorclaims, departmentcapabilities, andtoolsanddocumentation toassureawell-performingRCMteam. • Implement:Developsystems andmeasurestobill, followup, andpost the receipt of EOBs. Coach employees how to use these systems. Create revenue cycle SOPs customizedtoyourorganizationthat simplify the processof onboardingnew • employeesandcreatearoutineforoperations. • Measure:Institute regularreportingofrevenue cycle key performance indicators. • First determine thecurrent conditionofaccountsreceivable andRCM productivity

5. metrics.Then, provideregularupdatestoshowprogressduringthe engagement. Quantify the success of teammembers andhowtheircontributions affectcollectable accountsreceivable.ReporttotalcompanyRCMperformance inongoingmonthly managementconsultingmeetingswiththe Skytale team. Are you an owner with an appetite for growth? We’ve assembled a teamwith exactly the industry experience and expertise to help your business get where it needs to go. Contact ustoday! Andifyou’relookingforotherwaystogrowyourDSO,check outhowtoimprove the patient experience.