40: Centralized Billing and Call Centers

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Hello, everyone, and welcome to another episode of DSO Secrets. This is your fearless host, Emmett Scott, answering questions I've gotten on our Facebook page in preparation for the Adso Summit presentation I did. So this question going to put two together. It's all around centralization. Should I centralize a call center? Should I do a call center? Should I centralize billing? Now, I call these centralized services rather than support services. They're part of the dso, but financially I allocate them back to the practice to know how profitable the practice are. And I differentiate them in the fact that they are services that could be done at the practice level. But we've decided to centralize those for various pros. And I'll also talk through what the cons are as well in centralizing these services. So let's take on centralized call center first. Now, the big thing I would say here is to figure out when we use terms like should I centralize call center is what are the activities that you want your call center to be doing? Do you want them confirming appointments? Do you want them to follow up on unscheduled treatment? Do you want them to be able to schedule directly to the practice management software? Do you want them to just take overflow calls? Are they taking in referrals and leads that you're getting off of your website or from other new patient calls coming in? Are they gonna have texting and chat capability? Is it all going to be on the phone? Are you gonna have a routing system? Are you gonna have a way for individuals who are speaking different languages to route over to those that can speak those languages? So thinking through your call center is much more than just that central place that's grabbing all those front desk people and putting them in one place? What is it that I specifically want to happen? And quickly I have to start thinking through what's the technology and support that's going to be needed to pull this off at that level? Now let's go through the pros first. If I centralize the call center, I centralize training. I think this is a big part that all of us feel pain around with multiple locations far apart, trying to train people, especially in that front desk position, that can have some more turnover. Maybe we have some marketing activity that's going on. We want the scripting to be really strong. We want it to be consistent across our locations. And so centralizing that allows us to centralize that training. It also allows us to centralize that hiring. So as there's natural turnover, that there's going to be more in that front desk position, more in that call center piece. Having that centralized. Now I can have someone recruiting for that single at that single place, but covering multiple locations. And a pro and maybe a con is you also get centralized leadership, right? So now I can have one person who's overseeing everybody who would have been at a front desk somewhere else and getting a very consistent message there by having centralized leadership. So I'm not having to train practice managers to know how to train front desk people or train doctors to know how to train front desk people. I've got centralized leadership that can be really focused. That patient experience that's on the phone. And then one pro that again also turns into a con is there's a detachment from the practice that can benefit the patient. So I call it the 5pm no problem. What I mean by that is if I'm a patient and I'm calling into a practice and it's almost 5pm and I say, can I come in? And. And let's say that practice staff wants to kind of slow down, shut down. They have something they want to get to. They might say, you know what, we're busy. What about 10am Tomorrow? And they might push that patient's need off a call center. A centralized call center is going to say, 5pm no problem, let me get you scheduled. They're going to put them on the scheduling software, practice management software, and they're going to have that patient come right in. And so there's that detachment sometimes focuses more on the patient result than maybe on the practice needs. Now that leads me into my first con, which is there's a lot of work that has to be done to get practice alignment. There's something about having a decentralized service where the doctor, the practice or practice manager, really owns that front desk. And when schedules aren't perfect and they schedule something off, they learn from that. They own it. If they've got a bunch of kids Coming in same time as a root canal, they go, won't make that mistake again. Whereas a call center, that takes a lot more work to ensure that that scheduling flows according to what that doctor's capability is, according to those staff capabilities. And when you centralized, you tend to do standardized and so customization gets a little bit harder. So really making sure that you have practice alignment is critical as you centralize services. Of course you've got new real estate costs before there was people there at the front desk and the practice. It's not like you shut down, let's say 20 to 50 square feet and, and you say, oh man, that savings really offsets my real estate cost of centralizing call center. You're always going to have an extra real estate overhead by putting that call center at another location, which leads to technology costs. How do you get this centralized service to be able to schedule and communicate and coordinate with these practices in really a cost efficient way? And what about the technology costs of routing those phone numbers in and making sure that they're going to the right place? And so having a telephone system for all those calls, that's going to be a new technology cost that you have to think about all that hardware, et cetera, as you scale. And then you do have new leadership costs. You're not depending on that practice manager and doctor to lead those front desk people. Now you got new layers. And as that call center grows, you've got leadership teams, directors, if you will, over different subsections. Maybe you have different brands that need to be managed, or maybe you have different regions and time zones. So that leadership cost has to be thought through. So you're going to weigh these pros and these cons. Am I able to get better patient experience, better scheduling? Am I able to get the training and the hiring constraints that I had better organized? And then how am I going to offset then the new real estate costs, the practice alignment, the leadership costs and the technology cost to make all of this happen. Now, as you can imagine, billing, centralized billing has a lot of the same concepts. What part of the billing are you going to have centralized billing do? At what point are they going to step in? Are they just doing appeals? Are they just doing, posting? Are they sending out claims? Are they auditing those claims before they're sent out? What's the level of service that you want to provide at your centralized billing? What are you going to have done at the practice level? Now you get a lot of the same pros. You get the centralized training, centralized hiring, you even get and I'd say this on the call center too. You get more peer to peer training and coaching when you're centralized. So that's a big benefit. When someone's off at a practice by themselves, it's a little bit harder. Now you can create through social media some connections or you can create maybe a roster of people in the same position that they can reach out to. But there's nothing like having someone in the cubicle next to you to be able to talk through as a new hire. So having that support, having that centralized leadership as well, and if you're doing things like government pay or you're doing payment plans, each one of those can really benefit from centralized billing, government pay, because as I often say, those who are taking government funds don't make billing mistakes, they do fraud, waste and abuse. So the, the need to do that perfectly gets much more important when you're taking government insurance. So having that centralized allows you, as rules change and regulations change, to make sure that you're really sending out claims as appropriately and compliantly as you possibly can. And then you've got payment plans. And a lot of times those can become very disparate and disorganized. But centralizing that, having one person who's covering multiple offices can really be helpful as you build out that team to ensure that you're collecting on any kind of cash pay systems or payment plan systems, or even coordinating with outside vendors who might be helping you with payment plan systems. Now your cons are really similar. You're going to have new real estate costs possibly where now you've got to house all these people you're centralizing for billing. You've got leadership layers. You're not relying on your practice manager and doctor as much to make sure this happens. Which again, pros and cons to that. That means they can focus more on patient experience and practice trainings and so forth. But also means you need leadership now to oversee this growing billing team. And of course there's technology costs. Are they posting those EOBs? Are they pushing out those claims? How are they getting access? And what's the systems and processes and technology that supports all of that? So there you have it. That's centralized billing, that centralized call center. There's your pros and cons. So start weighing out now. If you have more questions on this, please join us over on DSO Secrets, our Facebook page. And until next time, keep smiling.

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