Revenue Cycle Management for DSOs

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Revenue Cycle Management for DSOs
As your DSO grows, so does the complexity of your
business. Keeping tabs on every patient
appointment, insurance provider, and payment type
gets more and more complicated the more patients
you treat. Thats where revenue cycle management
for DSOs comes in. We work with DSOs to fine
tune RCM as they scale. What is dental revenue
cycle management? Revenue cycle management (RCM)
is how healthcare organizations like DSOs collect
revenue, starting with the patients first
appointment and ending when insurance claims and
patient payments are complete. In other words, it
links the provider with patient benefits and
payor reimbursements.
The main steps of dental RCM include
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• Contracting and credentialing Establishing the
  contract for procedure
• 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 24-36 month basis,
  you can renew this to assure provider licensure
  and malpractice
• insurance are current and in good standing.
• Patient benefits verification Taking the info
  the office has collected from the patient and
  researching what benefits they actually have as
  part of their insurance plan. Its important to
  do this before the appointment so an accurate
  treatment planand financial estimatescan be
  provided. This increases case acceptance from
  patients and provides clarity to the office how
  they can bill the payor while minimizing patient
  frustrations.
• Claims processing Submitting a claim to the
  patients insurance company using the correct
  service codes.
• Reimbursement and cash posting Receiving
  reimbursement from the insurance
• company and collecting any outstanding payment
  from the patient for services provided.
• Claims follow-up Following up on outstanding
  claims (or patient balances) that
• are unpaid. If not conducted properly, this can
  lead to serious cash flow issues, especially
  when the business is dependent on a few main
  insurance payors for all its revenue. The
  process requires a claims specialist to call
  and/or use an online portal
• to review unpaid claims. Theyll supply any
  missing data to get the claim to be paid,

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• or appeal the claim to be reconsidered for
  payment when not paid or underpaid
• from what was expected in the reimbursement
  contract.
• Each step helps work toward receiving the highest
  possible reimbursement amount. The RCM process
  also helps ensure that accounts receivable is
  managed appropriately.
• How does RCM impact a DSOs bottom line?
• Well-functioning RCM should address each of the
  steps above. When done correctly, this financial
  process can help your practice keep tabs on every
  appointment, every service, and every
  outstanding claim to make sure everything makes
  its way to accounts receivable. The success of
  RCM can be measured in the total number and value
  of outstanding insurance claims and patient
  balances.
• If any of the steps fall behind, it can lead to
  increasing unpaid claimsand ultimately, a cash
  flow issue for the DSO. If providers are paid on
  collections, they might be unhappy without
  commensurate compensation. This can lead to
  turnover or write-offs.
• But when RCM functions well, accounts receivable
  is minimized. Providers work is reimbursed in a
  timely manner in accordance with the payor
  contracts. And the DSOs bottom line should stay
  in the black.
• 5 tips for improving RCM in your practice
• If your DSO would benefit from an improved RCM
  process, here are some tips to consider
• Update UCR (usual, customary, and reasonable)
  rates and payor fee schedules on an annual
  basis. Confirm contracting and credentialing for
  each provider.
• Assure claims are verified and batched on a daily
  basis.
• 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 than expected.

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• To improve your RCM and insurance accounts
  receivable, begin with what claims may time out
  of payor consideration by largest dollar amount.
• When tackling an outstanding claims issue,
  measure the issue in terms of
• accounts receivable as well as number of claims
  in each bucket. Accounts receivable issues are
  solved by addressing each claim, so set realistic
  goals for how many can be addressed each day or
  week per person.
• Consider hiring outside help. As you grow, its
  possible to outsource some of the RCM grunt
  work. We recommend companies like Inside
• Desk, Zentist, and Medusind.
• Dental RCM consulting with Skytale
• Revenue cycle management for DSOs is a complex
  process that many practices struggle to find
  effective solutions for. Thats why our DSO
  consultants work with clients to improve the RCM
  process. Its a great way to help DSOs improve
  their cash flow and accounts receivable.
• Heres how Skytale helps DSOs develop or optimize
  their RCM
• Assess Review existing billing and collection
  policies to identify areas causing risk to the
  prompt reimbursement from contracted payors.
  Provide recommendations on outstanding payor
  claims, department capabilities, and tools and
  documentation to assure a well-performing RCM
  team.
• Implement Develop systems and measures to bill,
  follow up, and post the receipt of EOBs. Coach
  employees how to use these systems. Create
  revenue cycle SOPs customized to your
  organization that simplify the process of
  onboarding new
• employees and create a routine for operations.
• Measure Institute regular reporting of revenue
  cycle key performance indicators.
• First determine the current condition of accounts
  receivable and RCM productivity

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metrics. Then, provide regular updates to show
progress during the engagement. Quantify the
success of team members and how their
contributions affect collectable accounts
receivable. Report total company RCM performance
in ongoing monthly management consulting
meetings with the Skytale team. Are you an owner
with an appetite for growth? Weve assembled a
team with exactly the industry experience and
expertise to help your business get where it
needs to go. Contact us today! And if youre
looking for other ways to grow your DSO, check
out how to improve the patient experience.