253: The Hidden Revenue Gaps Quietly Draining Millions from Dental Practices

She uncovered that there was over a million dollars of AR that was sitting inside of a practice that had been uncollected, that they just had no idea where it had gone wrong in the system. And so when we miss one step, it just grows and grows and grows.

Hi, I'm Emmett Scott, and just like you, I've had my ups and downs in the dental industry, but times are changing. The DEO has built a map of how to succeed in one of the most challenging industries to navigate. On this show, we talk to dental industry leaders, solve problems, and get the answers you need to face these challenging times and thrive. Welcome to DEO's Growth Secrets podcast for dental organizations. Now let's get started.

Hello, everyone, and welcome back to the show. I am Kendall, and today we've got a really exciting conversation lined up for our operators, DSOs and dental practice leaders who want to modernize revenue operations with without sacrificing the human touch. And I am so excited to introduce you to our guest, Rachel Grant, who is the VP of Dental Sales at Medusend. And Rachel brings over 22 years of experience in dental revenue cycle management, clinical leadership and practice operations. And over her career, she's helped grow revenue, expand market share, build strong relationships across the dental industry. But not only that, she's passionate about delivering innovative, efficient solutions that help practices scale profitability. And I'm really looking forward to diving into that today, Rachel. And so welcome to the show, my friend.

Yes, thank you. Thank you so much for having me.

Absolutely. Before we get into some of the hot topics, I want to reel back the reins a little bit here because I'm ready to just jump right in and learn all about it. Where did Megisense start? Start what? What inspired the company to focus on the dental space specifically? Could you give our listeners a brief history and a deeper understanding of Medusint?

Yeah, absolutely. So medicine is going into their 22nd year in revenue cycle management, started on the medical side and recognized a need in the dental space, which is a little bit behind the medical rev cycle as it stands today, and wanted to provide that solution as well as scalability for growing practices and growing DSOs to be able to leverage the revenue that those providers are working so hard for.

Amazing. So for our dental group listeners that are joining us today, what does medusyn actually specialize in? Can you paint a quick picture of the services you provide and who they're best suited for?

Yeah, absolutely. So that's the great thing is we are full spectrum, whether it's one to two locations all the way through 300 plus locations. MedusInd is built to support any area of vulnerability or the comprehensive rev cycle. So that can be a pain point of not enough hands to do insurance verification, raising insurance, aging and needing some triage in that area to see where that money is. Or we can help with everything in between. So specifically we're helping with credentialing, insurance verification, posting of payments, sending claims clean to get them turned around faster, and then following up on why any claims haven't paid and that money's still sitting out there. So really keeping the well oiled machine and the in house team able to serve their patients.

Amazing. So that full end to end, end revenue cycle management, you guys have it all from the start to the finish. I love that. All right, let's jump in here because we've got a lot to talk about today, my friend. I want to talk about the cracks that sometimes creep into the revenue cycle inside of our dental practice. And so from your perspective, I would love to hear where do you see the biggest cracks in the dental revenue cycle today? Specifically for maybe some of our smaller groups that are say one to two locations and the difference between what a bigger group, 10, 20, 30 locations might actually experience?

Sure, yeah, absolutely. And it's so interesting because when you're in one to two locations, they're similar problems. They just grow bigger as you add more locations. Right. So it's so important in that infancy to really get those system processes right, people in the right seats in order to scale that growth. So, so I think that the gaps that we find on the smaller location size really is, especially if they're looking to grow, implementing systems and processes, making sure things aren't falling through the cracks. Right. So you have that designated system of patient schedules, their insurance is verified and entered into the system and there's the subsequent treatment, treatment planning and sending over to insurance. And, and if any of those steps aren't completely covered, it creates those gaps. As those gaps are created, if we keep skipping over, they become craters, they become areas where revenue is just floating out the door. And sometimes it's even hard when those craters are created and you try to kind of triage put the band aid on. Unless you have a system that is tried and true and consistent, you're always putting on that band aid. So I think that's where the biggest cracks are created is when systems aren't kept because of lack of in office personnel. The difficulty that insurance puts on us with different policies, different coverage, different exclusions. It's a Layered effect. Yeah.

And I've definitely seen those layers in all of the layers like you've shared. Maybe it's a lack of system, maybe it's a lack of, you know, team burnout. Maybe it's something else. Maybe it's turnover that's happened inside of the practice and one small missed step leads exactly like you said to those big craters. I know we were talking with one of our coaches the other day and she's amazing and she uncovered that there was over $1 million of AR that was sitting inside of a practice that had been uncollected, that they just had no idea where it had gone wrong in the system. And, um, this is such an important process because exactly like you said, when we miss one step, it just grows and grows and grows. And then sometimes it gets to the point where it is unachievable to really rectify, you know, as one person and you do need that additional help and support from a company like Medusyn to be able to get in there and, and tackle it.

And so absolutely.

Do you find. Is there a tipping point where the crack starts to get bigger, where the, where the gap, you know, gets gets bigger? Is there something that you've seen in your history that, you know, really is the tipping point that it's like, if this isn't a really tight system, this can go sideways really quickly?

Yeah. I mean, I think it starts really with insurance verification. When the patient walks in the door, securing as much information as possible, you know, on average to get a fully comprehensive breakdown with your exclusions, your waiting periods, your missing tooth cloths, it's going to take on average about 40 to 40 minutes to an hour when you have to contact these insurance companies, especially those that aren't digitized with the information on a portal. And so if you think about your key contact up front, who also could be answering the phone, seating patients, welcoming patients, helping clinical assistance that are checking out patients, they're sitting on hold, they miss maybe a key piece of information, maybe it's that sneak date on a crown. Right. And then they have so many more verifications that they have to keep up with. So just tiny little errors along the way, unintentional errors because we're moving so fast, those. Then when that treatment is rendered and say the seat date or the missing tooth clause wasn't captured initially and that claim is denied or it's held up, those little tiny kind of blimps in our daily process then turns into those gaps, those craters where you need a team to come in Triage the problem and get it back to a healthy system.

Are there warning signs or any Data that our CEOs or operators should be looking for to really assess if their, their process is leaking revenue?

Yes, absolutely. So my favorite thing to look at is going to be your insurance aging report. Take a sample of some of those claims, call and find out what's going on with them. It's really, I like to say it's the emergency room the of your revenue cycle you're going to really be able to assess where are these damages coming from. Right. So is this claim still outstanding? Because this patient was never eligible in the first place. Did this claim pay zero because they were maxed on their benefits and it was based on prep date and not seat date of that crown. So that's where you can really see where are the errors happening in the front end of the cycle. They're causing this money to backpile. For instance, like that million dollar example that you had been given. If they were to call on a handful of those claims and kind of get an analysis, they get a synopsis of what's going on that's caused this million dollars to funnel into this book.

Absolutely. So what can DSOs do or single owner practices within the next 30 days to really improve their cash flow and operational efficiency without hiring more team members? Because we know right now that that is a lot of people's bane of existence is the cost of hiring. We're seeing, you know, through profit and loss statements, team wages starting to creep up, you know, year over year, month over month. And so what would you give our listeners as some suggestions to, to really help improve their cash flow?

Absolutely. So I think the biggest thing is utilizing your in office staff like you said, your most costly employees and the ones that are patient facing. Right. They, they are the brand of your this. So we don't want them spread so thin and stressed out on a daily basis because they're also trying to take care of the management and the rev cycle. So I think the one thing that you can that these practices can do from the start is to kind of dip their toes in outsourcing that they haven't before. You're going to have a service, a team that is exclusively dedicated for your practice. Their sole focus is the revenue cycle. So then there's not that pulled away attention and there's your internal teeth not being spread so thin which causes that stack turnover which is very costly. Right. When your patients get used to your team, that's what helps build that comfortability and that patient schedule of consistency. So I would say if you're, if you're needing to see a change, you know, rev, the revenue is not coming in the way that you want. Take a minute, look around your practice, see what valuable team members are overstretched and what are their tasks. Chances are they're insurance verification, insurance aging. So offlifting those tasks. Kind of like when you hire a babysitter because you need a date night off. Right. It's going to give you a better quality of life because you can focus on the patients and know that your revenue cycle is also taken care of.

Oh, I love that. Absolutely. And I know from a coaching perspective sometimes, you know, we hear the team is resistant to bring in, you know, outsourcing insurance verifications are a part of the revenue cycle management because they feel like perhaps it's almost like a penalty, like you're not doing your job over here. So we're going to outsource and take that away from you versus the other flip side of the mindset, which really is like this is taking you way too much time and we want to help and support you and take this off of your plate. So it's one less thing that you have to worry about, one less thing that you have to focus on so that you really can be forward facing and give that amazing, you know, exceptional patient care and greet the patients and not have one phone, one finger stuck to the phone and another one, you know, waving at your patient over here and trying to type with the other hand. And so it really is sometimes a mindset as well for our team members to overcome that outsourcing. But it is such an amazing opportunity for the team members when they have that extra set of support that gets brought into the office. As simple as something like a verifying insurance. So great.

And I could really relate to that. You know, I started my journey in the dental industry clinically and then moved into kind of a hybrid role and then obviously now more advocate for revenue cycle. And, and I think that I came into this role because I was that team member that was spread so thin. I was starting a family and I would go home and dream about what verifications I had done that next day, how it was going to push my day off and affect the schedul. And so I can relate with those that think that outsourcing could be a job replacement or something to say that they're not doing their job properly. But I would just challenge those team members to really think about like running a home. You don't hire a Housekeeper because you're not capable of cleaning your home. You hire them so that your focus and your energy is spent on other things that you're wanting to do, but the job still gets done. Right. Babysitter is the same thing. Babysitter doesn't replace mom and dad, but they give you some time to be mom and dad, you know, so it's just a way of changing your thinking about it. Utilizing outsource is a tool and a resource. It is a partnership. It is just like bringing someone into the office that's not physically there. You don't have to deal with personality conflicts or anything to that st. They're getting the job done for you and you guys can live your happy family. You know, we all know. I'm sure there's people out there that'll listen to this and chuckle because we all know how that works. Absolutely.

Absolutely. Sometimes I'm like, who if I didn't have to deal with those personalities?

Right. Right. Well, and imagine how much less stress. Right. I keep going back to the family. Because if you think about like if bills were taken off the table, if chores and dishes and laundry, think of how much less stress we would have and how much more we would enjoy. And then your patients feel that they feel when you're happy at work and you're focused on just that patient care and keeping the day to day going, but not having that, that next shelf of additional responsibilities, especially when dealing with insurance companies, is so exhausting and it never fails. You're waiting on hold and then they pick up and then they hang up and you got to start all over again. And it's hard to shift from that negative energy into positive patient care. Right. So it provides a balance, it streamlines the stress, but it also makes sure that the revenue cycle of the practice is healthy so that that job security is there that we can continue to support those patients and provide them that quality care.

I love it. So thinking about, you know, the end to end cycle for revenue cycle management that needs to happen inside of the practice, how much of this can really be automated out versus simply creating a better human work flow?

Sure. You know, I think it's, it's going back again to those tedious tasks. Right. So in the office, there's some key elements. Regardless if you're outsourcing end to end or tiny little blimps, whether you're just outsourcing insurance, aging, or just insurance verification, there's still the actions that take place in the office. Securing the patient information, getting them into the system. Those kind of things. But I would say where the offset is, is most of these practices are used to looking at the whole big picture of task, whereas now it's broken down to 20% of what it used to be. There's, there's that transition of trust, right, that I'm letting this go and someone else has it. But once that trust is established, just like in any new relationship, it becomes a part of that flow, it becomes a part of that system. So that now I know at the front desk if I have a patient that walks in and needs to be seated immediately, I've got a point of contact that I can call and I don't have to stop this treatment plan that I'm working on. I know my partner at MedusInd is working on that verification and I'm going to be able to get that patient seated. So it's more so a implement of stress reduction tasks, delegation and then your, your internal systems adapt around that because you now have that added resource.

Oh, I love that. So thinking about my bigger DSOs, a lot of the DSOs have you know, an in house insurance verification or they've got, you know, a few people that are verifying, doing, you know, checks and entering EOBs and all kinds of fun things. You know, in a, in a department it's two or three, you know, people that are there. And so how should these DSOs think about perhaps bringing in like a hybrid model into their practice? Like what belongs in house, what should be out source. Any thoughts on why for those bigger, larger practices, you know, 10, 25 practices?

Yeah, absolutely. You know, it's the same thing as when you're looking at one to two locations in my perspective. Right. So we have a centralized team now that's supporting multiple locations. Typically there's a system in a process C that they've started to establish that they're implementing. However, sometimes that can be challenging. Depends on how your rev cycle team is trained from person to person, how they support different locations and how you have that structured. So I think scalability is one of the biggest things that you can get with outsourcing. With a centralized team as acquisitions happen, software conversions, things that take them out of their normal day to day process that would add to the complexity. That's when outsourcing is going to come in as an additional kind of muscle and arm up support, support. I've also seen where they were able to take centralized teams and because like we had mentioned before, the employee cost of payroll is so substantial, now utilizing them more for revenue Building versus revenue surging. Right. So we've already produced this revenue. It's already a part of our collections. Now we're having to pay someone additionally to go and collect it. Right. So instead of paying that money that, that cost for employees to do that, we're going to have an outsourced company do it at a lower rate so that I can take my in house centralized team to working outstanding treatment plans, calling patients that are on recare, negotiating higher fee schedules, working with their Better Business Bureau to bring in more patients. Right. So just recycling their current centralized team to more revenue producing versus clean.

I love it. So just thinking, you know, in terms of like roi, if I've got one team member that you know is being pulled in multiple directions or perhaps working just the outsourcing, is it like a 2 to 1? Like can Medusa do like double the work is like one person can do? Are we using AI to automate this out or does Medusa still have human people that are doing that in the background and that's all that they're focused on? Talk to me a little bit about how that, that differentiation works between what we've got in a typical practice versus how you guys are operating on the back end.

Yeah, absolutely. So we do use a combination of AI and human expertise. We have found that it is needed for that dual combination in order to really get all of the information that we're needing from the insurance company as well as deal with the added complexity outside of AI and understanding. Right. So diagnosis codes, attachments, those types of things. So what we do is we partner our AI for efficiencies. So like you had said, work smarter, not harder, faster than a typical one person in an office can, as well as that human counterpart. So that if there are those added complexities, prep, receipt, date, waiting periods, things that AI just hasn't been smart enough or the insurance companies this API doesn't provide, that's where we fill in that void for that comprehensive support.

I love it. Where do you really see AI? We, we love AI over here at deo and so where have you seen the biggest growth in AI that's actually supporting our RCM systems for practices? I would love to. Is it like insurance verification coding?

What?

I just want to hear your perspective on that.

Do you mean specific in rev cycle or things that complement or really like grow the rev cycle area?

Yeah, specifically like the rev. The rev cycle or the growth of the rev cycle. Where do you see? I going with our.

I mean I, I personally think that the AI imaging Softwares for supportive diagnosis and treatment planning is a huge impact in our industry right now. Patients can visually see the carries and areas that these PA that these providers are talking about. Why the importance of phasing out different areas of treatment plan and actually fulfilling that treatment. I think that's going to. That is one of the biggest AI improvements in our industry to be able to have that patient education. And it directly affects our rev cycle because not only do we have a diagnosis tool that we can utilize to justify with insurance carriers, we're going to get higher treatment plan acceptance and then it allows our internal team the resources we need to justify to the insurance company so that they pay immediately and it's not that long. Waiting game.

Oh, so good. We love AI. Absolutely. Seen a huge growth in exactly like you said, those diagnostic tools. But it's interesting to hear how we companies, DSOs, small businesses are able to actually use that in their supporting documentation to verify, you know, why they did this treatment or what the doctors are seeing. Perhaps because I know sometimes the people that are working on the insurance companies, they don't have that in depth world of dentistry. They don't know what our doctors are seeing and why they decided to do the treatment plan the way that they did. And so using that AI, additional documentation and hearing that it's really helping the revenue cycle management process is, is super exciting.

Yeah, absolutely.

Is there a part of the revenue cycle that you, that you think or maybe that medusind is strongly believing in that there's always going to be a need for a trained human expert. Like no matter how good the tech

gets, I think to be honest, insurance verification is going to be one and payment posting, I know that there's a lot of automated payment posting. I would say probably I would sprinkle on top the insurance aging because as we know talking when we call an insurance company, as many of us have, and we've talked with the automated recording or we've gotten on the portal, it gets frustrating because you're, you're stonewalled. There's so much limited information that you can actually access of importance. Then you have to get on hold, you have to talk with the rep. Sometimes you get a great rep that knows what they're talking about. Sometimes they don't tell you anything and then they push you off to the next one. So I think with, with those things being said, verification, the reason that I would say that would be first and foremost is due to the complexity. Providers are getting very smart on how to code, how to stay up with the coding changes and in order for us to make sure that we're treatment planning properly and getting the closest estimate of coverage, we also have to make sure that the information we're receiving is accurate. So an AI pool will get that initial information. But we really need to talk with a representative to fill in those missing gaps to make that comprehensive coverage. I haven't seen one insurance company yet that allows that AI click of a button with comprehensive information. So I think that's definitely an area where, where the combination fills the void. When it comes to payment posting. That's a huge vulnerability. We want to make sure that our payments are posted, adjusted balanced properly so that to have the AI counterpart to be able to have the efficiency, especially for DSOs that are receiving bolt payments, large payments on a daily basis, the efficiency of getting them in the system partnered with the human capability of accuracy and audit is the winning combination. In my, my perspective. I know if I was the provider in that labor some position every day I want to make sure that what I'm working for is getting collected properly and posted properly. Right. And then I would say lastly, with your insurance aging again, AI is great way to scrub the initial information. Filling in the back end on, maybe it's stuck in the system. AI can't talk to AI to get it pushed through that system. So that's where that human interface comes into play to make sure that we can fill any of those voids, those deficits that computers aren't going to be smart enough to, to push us out of, you know, that human brain. So it's a great addition, but we, it's that added muscle to what we've already been doing so well. So we can't lose a little bit of that human expertise for sure.

So when our offices or DSOs partner with Medusyn, do they get like a team on the back end? What happens there? Can you walk me through how Medusin sets up our practices to make sure they're supported? And obviously it's going to be different, you know, based on the fact of if they're just doing verifications or if they're doing multiple things, but give our listeners a little bit of an understanding of what they get, so to speak, in terms of help and support from MedusInd.

Yeah. So we do have a fully exclusive dedicated teams. And what I mean by that is that team is only working on your account. They will never be working on any other account for the life cycle that you're with medusynd. I think that's Very important because sometimes it can get easy to maybe have overlap of one standard operating procedure to another. So having that clear tunnel focus for your practice is really important to us here at medusend as well. We have trained specialized staff in each of our services. No matter what composition of service structure that you make, you're going to have experience, tried and true, along with management and our quality assurance department. So you have a multi layered approach to your outsourcing team, just as if you would want to create in your practice through hiring, through processes, procedures and training. We make sure to take that highest quality at Meduson so that we can provide that quality service.

Amazing. How long does it take for a practice to get fully integrated and rolled over and up and running? Is there a lot of, you know, lifting that has to happen from the team's perspective before you can get up and rolling? Or what does the life cycle look like before we're ready to rock and roll?

Yeah. So it's a pretty quick launch, I would say two to three weeks, Two weeks more so for our cloud users and the implementation is customized based on the need of the practice of the group. So some come in with systems and processes that they're looking to have more of a additional set of hands. They don't have the hands, they have high turnover. They can't keep those seats filled. So we can come in and keep those standard operating procedures in place by providing them that scalable support. And others are really just looking for. They've never really had any systems or they need an added layer of expertise so we can really come in and support the practices where there are with their end goal in mind. So if we need to develop the standard operating procedures and put that system in place for them, we can. If they're wanting us to continue what they've already built with those extra hands, we can do that as well. And anywhere in the middle of that.

Ooh, I love that. Makes my heart so happy. Hearing the word sop first and foremost from a coach is like everything. But really what I heard as you were speaking, there was like, there's additional training and help and support for some of those team members who perhaps might not know what they don't know. I can, I can imagine and I've been in situations where you. Somebody's come in, they were trained by somebody, that part of the system was broken to begin with and now it just keeps being, you know, broken and smashed and crashed and dug into a hole. But now MedusInd is going to come in, you're going to help identify something in the system that's not working or you know, is exactly as it needs to be. Hence why the claims are being hung up and not paid in time. And I would assume, and I would love to hear more about this, that like you're going to communicate with that office and say, hey, this is what we're noticing about the lapse claims that have gone out. We're always missing this. We don't have the right X, Y and Z on it. And so the team is also going to receive that training and support to then be able to plug the holes and have better systems moving forward to prevent that from happening again. And that from a coaching perspective and team members perspective is so exciting. But talk to me a little bit more about that and how does it work?

Well, and it really is important. I mean it's kind of just like lifting the rug to see if there's any bugs and what kind of bugs they are in order to know how to kill them. Right. So we even get down to the granular, granular level. So when it comes to your insurance aging, you can very well see what insurance companies do. You have a high denial rate. Is there a certain procedure that that is. Maybe it's your crowns are all coming back denied because there's no final or root canal, there's no final film or there's no seat date for your crowns and that's why those claims aren't coming through. So from a granular perspective you can really. Hey Dr. Smith, it looks like MetLife is denying all of your crowns. We're going to need to make sure we get a seat date or your final films look great or your, your, your, your root canal procedures are going great, but we can't get them paid because we don't have a final film. So it really is empowering our providers to make sure that we have all of the information that we need to get those procedures paid for in a timely manner.

Oh, this has been amazing. Rachel. Thank you so much for sharing all of your insights before we there one or two pieces, pieces of advice that you'd like to give our listeners today that perhaps are still on the fence about outsourcing part or even all of their revenue cycle management.

Yeah, absolutely. You know, from someone that was in those seats where you're juggling, you don't have enough arms from like a, in office perspective, I would say it's definitely worth exploring. I'm sure we've all had the curiosity of what it would be like to have a personal chef or a housekeeper or a car service. Right. It's not necessarily a luxury in the dental industry to have outsourcing as more of a capability of empowering you in a resource in your practice to do better patient care. So don't let the, the nervousness keep you away. It is something that really gives you back that quality of life where you are waking up and excited to go into the practice because the monotony of the rev cycle and all of the tasks have been stripped away and you can get back to just enjoying dentistry.

Wonderful. That was a fantastic conversation. Thank you so much, Rachel, for sharing, for joining our show, giving your experiences, your perspective, your thoughts. We're so excited to have had this conversation with you today. To our audience, thank you for tuning in. If you're running a dental practice or DSO and you'd like to learn more about revenue cycle management, please go and check out Medusyn's website. You can find them at www.medusind.m e d u s I n d.com and until next time, my friends, keep smiling.

Thank you for listening to deo's Growth Secrets podcast for dental organizations. Continue the conversation on our Facebook group and meet other dental leaders. Get questions answered and the strategies you need to succeed. Plus, we have some free resources for you right there on the Facebook page. Remember, you're not alone. Let's do this together. Join DEO's Growth Secrets Group on Facebook. And until next time, keep smiling.