255: How Dental Practices Unlock 30% More Revenue Through Revenue Cycle Management

I've seen revenue jump as high as 30% because the front office goes from doing these tedious, time consuming things to connecting and selling dentistry. And it's such a game changer. And when you see that top line lift while your bottom line still grows, it is a no brainer. It pays for itself.

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, solve problems and get you 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.

Well, hello and welcome back to this episode on the DEO Podcast. I am Jordan McIntyre, your host and if you're running a dental practice or a DSO and you've ever looked at your revenue numbers and thought something feels off here, but I can't quite put my finger on it. Well, you're in the right place at the right time. This episode is for you. Today on this episode, we're going to be diving deep into revenue cycle management and not the boring stuff. Here's your AR report. We all have that kind of talk too much. So today we're actually going to be going into the stuff that actually keeps your cash flowing, your teams sane, and your practice is profitable. Before we dive in, I just want to give you a quick reminder. If you're getting value from any of these conversations, please make sure that you share you like all the fun stuff. Let's make sure your colleagues can hear what's coming up. So we have a guest with us today. So I'm super excited to have Ms. Nina Lewis with me today. Nina, welcome to the Call. So Nina is the vice president of the revenue cycle management at Support DDS. She has been in the dental industry for over 25 years, which means that she has seen it all, literally. So as you hear her story, you'll see why I say that. Nina has spent her career building practices and DSOs strengthen their cash flow. All of you listening, I'm sure you're like, okay, that sounds great. She's improved operational performances. She's built revenue cycle systems that actually work. Here's what I love about Nina is she is actually known for taking complex financial data and turning it into clear, actionable insights and that it is exactly what we need. So, Nina, welcome to the show.

Thank you. I'm so happy to be here. Thanks for having me.

So before we kind of get into the heavy stuff, I have to know, 25 years, is that just in, like dental revenue cycle what got you into this world and what's really keeping you in this space?

I would say 22 of it was probably all revenue cycle. The first few years. I was actually chairside assisting, which is how I started. And I, I actually think that's beneficial to me because it has allowed me to have empathy to patients when they were calling an office or they had a question about their bill, but also their tooth hurt, so I could really talk clinical. So it has been beneficial. But, yeah, it has been a journey. What has kept me here is I love helping people fix things and I like seeing results, but I also love coaching and mentoring team members on my team so that they can elevate them themselves into a bigger career as well. So that's really what keeps me here.

I love that. I love that. So you're really like a win, win for both. Not just the team, not just the owners. We know we, we want you to get the money that you deserve, but really giving opportunities to your team. So, yeah, I love your story.

Thanks.

All right, well, let's dive into the fun stuff here. So I'm gonna start with something I hear all the time. Um, practice owners are looking at their AR total and there's two things that we're doing. They either panic or they're celebrating. And it's normally based on like one number. And I'm sure you can relate where you're like, ah, so one number doesn't really tell the full story. But you say, I want you to break that down for me. What do you mean when you say AR doesn't really tell the full story? What are people missing?

Well, I think that a lot of people see the dollar amount initially as the concerning part. And quite frankly, that's really not the full story. Right. So you should have a large 0 to 30 AR. That means you produced a lot and you should be collecting a lot. To me, the more concerning number is what is your over 90 look like? It's the aged claims that tell the story of operationally where you have gaps or learning opportunities and things that can be improved upon.

I love that. So then what I'm hearing you say is like the aha moment is when you double click into that over 90, you start to kind of see some trends and what's happening.

Yes. And I would say beyond that, as you look at your over 90, it's. That's great. If you're going to go work it and try to figure it all out. But if you're not actually tracking what's going on with the over nine 90 to find the trends to then help your internal team. So great, fix it. All that. But you want to know of those 200 claims, 50 of them are denied because of this. 30 of them we had to resend to the insurance because of this. And all of those things never really should have happened. Right. That's a. That that should have been fixed at the beginning stages. But if you don't know the why, you can't fix it.

Got it. Okay, so I'm curious for our listeners that are listening, we're going to touch on this early on that way those of you that are like ah, my ar, fine, this isn't relevant to me. I'm going to get, I'm going to get you engaged right now. So Nina, give me an example of. And you don't have to drop names but give me an example of a practice that thought they were fine, but they weren't. And walk me through what were those early warning signs that you were saying?

Yeah, so we had an organization that it was really project based, just so you know. So they wanted help cleaning things up as quick as possible. And that's kind of a, that's a concerning statement. Right. Because you don't know, they don't know what the problem is and we don't know what the problem is and it takes time to figure those things out. So as we worked their claims, what they thought was money that should be coming in really quickly because they thought that they were signed up for efts. Come to find out, some several people in the office kept changing it back and forth so that, that alone is such a huge delay. Right. It takes time to enroll and then it takes time to unenroll and then to re enroll. So there were thousands of dollars, hundreds of thousands of dollars that were kind of just in limbo and in order to fix it we had to get them re signed up for efts, confirm that all of that was going to be sent back. But the amount of time that was wasted because of honestly miscommunication internally on why they didn't like EFTs and why they wanted paper checks which you and I both know EFT is the golden standard.

100%. Yeah.

So don't let anyone talk you out of that. Is the takeaway. Don't ever let you out of that.

Yes. And the fear part is like the workflow they're always worried about changing change. Change is hard. But once you master that workflow, like I don't know about you, but if I do dentistry and I can get a paycheck in my bank account or at least a deposit within a week, I'm taking the deposit within a week.

Yes.

So, yeah, game changer, you guys. If you're not on EFTs, 100% agree with Nina. It is the way to go. Get your team trained up on that workflow. It's game changer for sure. Okay.

Yeah.

So I'm curious. So with Support dds, tell me a little bit about, like when you get in, you're starting with a group, you see these kind of early warning signs. I call it what does your relationship look like? How do you have these conversations? Do you do like training? Are you working with the owners? Tell me a little bit about that.

So that is a great question. So what I first want to say is to remember that Support DDS isn't a dental billing company. Right. We are a, a team member company. So we're, we're giving you a team member to really have them do whatever it is you want. Yes. We have a specialty of handling revenue cycle management. So really it starts at the beginning of what is it that you want your team member doing? So we can do full cycle RCM or we can just do one aspect of it or a few aspects. So for example, if we were working someone's insurance, aging for them, we would talk about what are the goals, what are the KPIs. This is what we expect to have happen in 90 days as we start working it and we see those trends that you're referring to. We have a weekly touchpoint meeting with typically a point of contact. Now it's usually an office manager. Sometimes. Yes, doctors are very involved, sometimes CEOs. CEOs. It just really depends on the dynamic and what the organization looks like. But at that time, we're going to review what have we worked on in the previous week or month? What were the outcomes of that? These are the trends and the concerns that we have. Would you like to hear suggestions? Not everybody. Some people have amazing coaches like you, Jordan. So they don't necessarily want our suggestions because you are guiding them as well. But if they want to hear them, we're absolutely going to give you the suggestions of what should fix this, what industry standard is and kind of moving forward, this is what we should, what we should try to accomplish.

Love it. Okay. Because I think that's where the missing piece normally is. When you have a support team. So I'm going to double click on something she said, and I think it's really important. Something that makes support dds, at least in my experience, unique has been that it's not a billing company. It's not someone that's coming in saying, I'm going to solve all your world problems. You're actually coming in and saying, hey, I'm a part of your team. So let's get the training, let's work into your workflow. How do you organize things? How do you work? You're really integrating with the team, which I think is super unique for you guys and not an easy shoe. So I'm curious, like, what's the best practice that you've kind of seen as you guys are integrating into those teams? What does that look like?

Yeah. So I want to just touch on one thing. If an organization came and said, we have no systems, we need you to do that, we will also do that. But I mean, you can imagine most people have some type of system. They want us to follow our protocol, so we will follow that. Really the way that it works best is we. So we have an initial launch call where we go through expectations, we ask some questions, and then we get started. And as you start working at day one, day two, we're going to find those gaps of, okay, we don't. We don't have the answer to this. So we need to touch base on that and determine how they want us to handle it. If they have SOPs already written out, they will share those with us. There are also some organizations who want to get on a call, a zoom call, for maybe four hours on the first day, run through. This is how we do it. This is what we want you to do. And on that call, we would have not only the team member, but I would have some of my leadership team on that call to also make sure that they're able to support that team member on those processes.

Oh, I love that. Okay, so, you know, what I'm hearing is because you're basically, you're removing roles in the office, so you're kind of solving another problem, which is staffing at these offices. Are you seeing that be a huge aha too? Of like, hey, you have a lot of turnover. Let's take this on. And now you don't have to keep reteaching people. What's your staffing? What's your turnover? Tell me a little bit about that.

So, yes, it's. It is a major issue right now in the States. You know, that everyone looking for help only we could become a virtual hygienist. I think we would solve a lot of people's problems. So yeah, it solves that. But I also want to say it also can complement those internal teams. Right. It's what sometimes can happen is an internal team feels like they're going to lose their job because the boss is bringing in this virtual support. And that's not always the case. It's to take off those time consuming tasks that someone at the front desk really just puts on the back burner every single day, doesn't have time for it. And quite frankly, most of those people were hired because they have amazing personalities and they're meant to be talking to patients, not insurance companies. So I like to look at it that way as I love that we're complimenting the internal team in regards to turnover. For us, our attrition rate is, is really low for the industry and it really has to do with our internal culture and the things that we do for our team members. So things like we have pastoral care for them so if they lost a family member or they're having mental health issues or, you know, whatever it may be, they have someone right there to talk to as opposed to having to leave, go find somebody. We have medical care on site for them. So same thing. If they're feeling sick, they don't have to leave the building and go to their doctor. We have it right, right there for them. We have other things like our own mini Starbucks. We call it the Grind. So they have access to that because remember they're working stateside hours, which for them it means they're usually starting between 12 and 3 o' clock their time. So coffee is important. We also provide transportation because they're leaving anywhere from midnight to 3am and we obviously want them to get home safely and feel that, that we're taking care of them. So those are just some of the things that make our attrition rate really low.

I love that. I think that's awesome that you guys do have investment. It's huge. It's not great for your team, but it's good for obviously the clients that you guys are working with because less turnover, less change, consistency is really important, especially the RCM world.

So yes.

Yeah, that is awesome. Okay, so I'm going to shift gears just a little bit. I want to kind of go into, I'm going to call it like the real talk. Right. You kind of touched on it where team members feel, hey, when support groups comes in, like, oh God, my Job's on the, on the line. They're also kind of feeling this way with AI. So everyone's talking a lot about AI right now, every vendor, every conference. So I'm just kind of curious, what's the actual role in AI in RCM today? Are you guys utilizing it? Tell me a little bit about that.

Okay, so I'll start with the easy of are we using it? So we function with whatever a client functions with. So if they're using any type of support with AI, we will use that. So we use their softwares, their Google sheets, anything that they have, we use. Where do I see it going? So I think AI is great. I don't get me wrong, I think that it's solves efficiency concerns, I think it makes us faster. But there in, from what I know, there is no AI out there right now that can handle even one task in its entirety. So let's just use insurance verification. There is no company out there right now that can get 100% of insurance verifications for you. I would say the average right now is 60 to 70%. So who's going to handle the remaining 30 to 40? A human. Right. And AI is only as good as what the insurance companies put on their websites. And we all know every website looks different. Every company thinks certain things are important and other things are not, which generally requires some type of phone call at some point or another. The other thing about AI is that I think it's great for sorting or flagging or spotting patterns, but it doesn't replace the judgment of what a human can offer you. It also doesn't fix operational issues. So if you're, if you have issues going on and you implement AI, the information is only as good as what you already gave it. So to me, it's not the cure all. Fix all of everything. Not in our world. There's other, there's other industries, sure, but not for this. It's, it's a, it's a tool. That's all it is. It's a tool to help you be quicker at revenue cycle management, which is a, it's a beast.

So, okay, I'm glad you're saying that because I hear that a lot, especially as like members I'm speaking with. We all kind of are really getting on this AI train. But what I'm hearing you say is like, hey, the AI is kind of like a support. It does what the websites can give you, online can give you, but you still need a human. So I'm hearing that like you still need a Human involved here is what I'm thinking of. Okay.

Yeah.

Okay. Have you supported any practices that are using AI and like, do you guys work?

Oh, yeah, yeah. We have plenty of groups that have a tool available. And, you know, really what it is is had they come to us prior to implementing that AI tool, they might have needed two people to do that job. Now they have this tool and they need one person to help support it. So, yeah, it's. And we've, we've dabbled in every single one of them there. You know, I have my favorites, but I'm not going to. We're not going to verbally say those out lo on a recording.

I love it. Love it. All right, so let's kind of talk about some KPIs. This is the juicy stuff, right? So. And I'm sure this is the stuff that you, that you thrive on a little bit too. So I just want to hear from you what's healthy ar, like, what is the KPIs they should be looking at? What should they be talking about? Help us out, understand that a little bit.

So when you're looking at your insurance aging, I would recommend someone looking at the percentage of each bucket in relation to your total air. There's industry standards for what all of those look like. In fact, I think we offered most of your clients, like a free RCM assessment, which is something we can talk about during that time. On what a healthy 30 to 60 is. What percentage should that be? But generally, right when you ask an organization what it looks like, they don't really. They may guess what they're. Oh, I think it's about $120,000. But then if you ask them to really break that down, they really don't have an understanding of what each bucket. So 30 to 60, 60 to 90, those type of things, or even the difference between what is patient and what is insurance. And those are all very different numbers and things you should be tracking.

Got it. So I'm curious to hear if we're talking about healthy rcm. So we want to know is your, like, is your revenue cycle healthy in your world? What's. What's the one thing that you would quickly say you're healthy or not healthy?

Are your claims paid the first time around? If the answer is yes, you probably don't have a ton of outstanding aging is my guess. But I haven't heard many people say yes to that question, so. Or even what is your clean claim rate? If they know that, they probably have a good pulse on. On what's actually happening.

So what happens if listeners today are like, I think my claims are getting paid on the first go around. I don't know, like, why wouldn't it be paid on the first go around? Tell them, educate them a little bit on that.

Wrong ID numbers, improper usage of codes, attachments, missing notes aren't clear. Narratives are missing all of the details that go into getting it paid the first time by someone. And let's be honest, this, there's these people are sitting at a desk reviewing this information that you sent over. So you either sent it all or you didn't. And, or it's accurate or it's not. You know, it's one small thing can make a $3,000 claim. Just sit there and it feels like insurances are less willing to tell you, hey, this is being denied for this reason. Right. It seems like there's a lot of runaround of figuring out the why it wasn't really paid.

Yeah. So the denial piece, because I think we get that a lot with like narratives. Right. They're like, oh, there's not enough information in this and use stronger narratives. Stronger narratives. So I think having support, and this is where I'll say about support dds, at least you have someone on your team that speaks the language. So if you are seeing denials, you are seeing these things. Correct me if I'm wrong, Nina, but it sounds like even the assigned team member, if they're seeing something, they still have an internal team with you guys that they can come ask questions with. Okay.

Yeah. And everyone who supports those team members on my team have done revenue cycle management before, so they have been with a client previous to being promoted into these roles for over a year. And, and we continue to train my leadership team. So the support team to the team members, we are constantly training them on areas that maybe they haven't done before, but we get them up to speed on understanding it.

I love it. All right, Nina, so as we're kind of going into this wrap up session, I'm kind of curious from you. When you are saying, hey, everyone has an avatar.

Right.

So normally for every, you know, vendor you work with, there's typically clients that are like, you might not be the best match, but then there's clients like, you're our person, you're our group. What is support DDS avatar? What would those that are listening right now, what's the type of business or type of office size, etc. That you feel could really benefit from your services?

Oh goodness. So I think that those single practices the concern with a single practice is that they usually rely on one person internally to handle all of this. And I used to be this person, uh, and when something was wrong with one of my kids or I had to have surgery, it was very stressful for me, but also for the owner of the practice. So I think if you're going to run a healthy practice and, and there's a lot of practices who are very slim. Right. On their, on their staffing and that's okay. I understand the why behind it. But what if something happen? Wouldn't you rather invest in a support team member to support your internal team in case something happens? And then also, I mean, if you think about it, one or two claims, like medium to large claims that we could help get paid would really cover the cost of what our monthly charges. If you, if you think about it that way, it's really worth having an extra layer of support. So that's what I'm going to say about single practices. Really. You know, my, where I see the most need is I would say those five plus, and that's because they're, they're scaling but they cannot keep up. Right. So they can't keep team members or they're buying practices all at the same time and they can't clean up all. They are quick enough. They need help with conversions, things like that. So those are probably my favorite or, you know, the five plus, because it's also, it's more of a challenge, it's fun and, and we're utilized more, if that makes sense.

Yeah, I love that. Okay, so really what I'm hearing is it really, no matter what journey, where they're at in their journey, you guys can plug and play. So whether it's a, it's a one, one practice or five plus practice, you have the workflow and you have the team to kind of plug and play. That's awesome.

Absolutely. Yeah.

Okay, so for everyone listening, I would love for you to kind of touch on what if they're thinking right now, okay, now I need to go look at my RCM because I really don't know what this looks like. Nina, where should they start? What's the first step that you'd recommend?

I would say look at your. To start, look at your over 90. Is there a large amount of claims? Don't necessarily look at the dollar amount, but is there a large amount of claims that are there? If you look at, you know, how many claims you send out in a month, if you have 50% of those sitting in your over 90 that's concerning, right? So if you send out, I'm just going to use easy numbers here. If you send out a hundred claims in a month, that means on average in your 0 to 30 you're going to have a hundred claims kind of sitting there on average, right. As they cycle through. But if in your over 90 you have 50, that's a problem because 50 of them, those 50 should have gotten paid that first time around. So I would start there and, and not just fixing them, but tracking why they're there. What are the, what are the actual reasons so that you can fix it on the front end moving forward.

Love it, love it, love it. All right guys, that is an important nugget. So take that back. If you're wondering where do I start? Start there. And I don't know about you, but I don't know very many groups that are just as hungry as you are to like get the money. I always say like the rep cycle team should be the ones like get the money, honey. Like that is all that they're focus on is how do I get this money? And you guys, they obsess with it. It is quite entertaining. If you've ever spent time with like a tracer or someone that's fallen up on claims, man, when you guys get those claims paid, it's like Christmas. It's like everyone celebrating. You get a denial that all of a sudden we get an approval. It's like yes. So I think it's awesome what you're doing, what you're building, keep doing it. We really need it out here in this space. And I'm sure everyone that's listening is like, yeah, this sounds great. I also want to just put a personal plug so you guys know with utilizing support DDS and offloading some of these things in my own personal practices that I support, I've seen revenue jump as high as 30% because the front office goes from doing the, even though they, some of them, I like it. They go from doing these tedious, time consuming things to connecting and selling dentistry and it's, it's such a game changer. And when you see that top line lift while your bottom line still grows, it is a no brainer, it pays for itself. So I think that's awesome. Well, thank you so much Nina for coming on. Been absolutely amazing. This is exactly the conversation I feel like this audience needed to hear. Especially wrapping up the year. I know people are going to be taking notes and they're probably wondering, well, how do I get in touch with this lovely lady, where do I go? How. How can they get in touch with you or your team?

Super simple. It's Nina. Support dds.com boom.

Blow her email up. I want her to see. See the motion coming from here. We really appreciate all of your insight, Nina. Thank you so much. Those of you that have been listening, thank you for spending this time with us. Remember that your revenue cycle is not just about numbers on a report. It is actually the heartbeat of your practice. And I really mean that. You guys work hard. You're pumping out the dentistry. Your bank account should show the same thing. You should see that money coming back in. So this is what keeps your team paid. This is what keeps your doors open, and this is what helps you serve your patients. So support DDS is here for the challenge. Reach out to them. Let them come out and help you guys. Until next time, keep building, keep growing, keep smiling. We don't want you to survive. We want you to thrive. So until next time, see you later.

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