Revenue Cycle Management for DSOs

7 min read

If your DSO grows as will how complex your company. The process of keeping track of each patient's appointment or insurance provider and payment method becomes ever more complex as you see more patients. This is the point where the revenue cycle management of DSOs comes into. We collaborate with DSOs to tweak RCM when they expand.

What is the role of dental managing the revenue cycle?

The process of revenue cycle management (RCM) is the method by which healthcare providers such as DSOs make money, beginning at the first visit of a patient and ending after the patient's insurance claim and payment are completed. This, in turn, connects the healthcare provider to insurance benefits for patients and reimbursements to payers.

The primary steps of dental RCM comprise:

  • Credentialing and contracting: Establishing the contract for procedure reimbursements, or changing them each time for 36 months or as often. Credentialing is a form of authorization to sign a doctor in accordance with the reimbursement contract. For a period of 24 to 36 months it is possible to renew the credentialing to ensure that the license of your provider and malpractice insurance is current with good standing.
  • Benefits verification for the patient: Taking the info that the office has collected from the patient and analyzing the benefits they are entitled to in their health insurance. It is important to verify this prior to your appointment so an accurate treatment plan, as well as estimates of financials can be presented. This helps increase the level of acceptance for patients and helps explain to the office on how they can bill the payer and reduce patient complaints.
  • Processing of claims: Submitting a claim to the insurance company of the patient with the proper service codes.
  • Payment and posting of cash Reimbursement from the insurance company, and receiving any outstanding payments from the patient for the services rendered.
  • Follow-up on claims:Following up on outstanding claims (or patient balances) that have not been paid. If the process isn't done properly this could result in grave cash flow issues particularly if the company is dependent on one or two major insurance providers to generate all of its income. The process involves a claims expert to contact the company or an online platform to look over the unpaid claims. They'll provide any missing information for the claim to be paid and "appeal" the claim to be reviewed for payment if the claim is not paid or overpaid from what was anticipated in the reimbursement agreement.

Each step is a way to work towards receiving the maximum reimbursement amount. The RCM process helps to ensure the accounts receivable are properly managed.

What is the impact of RCM affect the bottom line of a DSO?

A well-functioning RCM should be able to address each of the above steps. When it is done correctly this process will assist your practice to keep track on each appointment, every service, and each unpaid claim to ensure everything is sent to accounts payable. The effectiveness in the implementation of RCM can be assessed by the total value and number for outstanding medical claims as well as balances of patients.

If any of the steps are in the wrong direction, it could result in a rise in unpaid claims and, eventually the cash flow problem to the DSO. If providers are being paid through collections, they could not be satisfied with their compensation. This could result in turnover or writing-offs.

When RCM is working properly, the amount of accounts receivable are reduced. Work done by providers is paid on time and according to the agreements with the payer. The bottom line of the DSO should remain within the red.

Five tips to improve RCM during your training

If you think your DSO could benefit from a more efficient RCM process Here are some suggestions to take into consideration:

Update UCR (usual standard, customary, and reasonable) rates and payor fee schedules annually. every year. Verify the contracting and credentialing of each service.

Assure claims are vetted and batched daily.

Know that each payer has a standard time frame for paying. Note this for each payer and monitor claims that are delayed beyond what was the expected timeframe.

To enhance your insurance and RCM accounts receivables, begin by looking at the claims that could be timed out of consideration or payment by the most dollars.

In tackling an outstanding claims problem, consider the issue in terms of the accounts receivable and the number of claims per bucket. Issues with accounts receivable can be resolved by dealing with each claim, so establish realistic goals to determine how many claims will be dealt with each week or day for each person.

Consider hiring outside help. As you expand it is possible to outsource a portion of the RCM tasks. We suggest companies such as Inside DeskZentist as well as Medusind.

Dental RCM consulting with Skytale

The management of revenue cycle for DSOs is a complicated procedure that many businesses are unable to come up with efficient solutions to. This is the reason our DSO consultants collaborate with our clients to improve this RCM process. It's a great method to assist DSOs increase their ability to pay cash as well as accounts payable.

Here's how Skytale assists DSOs to improve or develop their RCM

  • Examine: Review existing billing and collection policies to determine areas of risk to timely reimbursement of contracted payers. Make recommendations regarding outstanding payer claims, capabilities of the department, and the tools and documentation needed to ensure a high-performing RCM team.
  • Implementation:Develop systems and measures to bill, follow-up and publish the EOB receipt. Help employees learn how to utilize these methods. Develop revenue cycle SOPs tailored for your business that will simplify the process of integrating new employees. It also creates an operational routine.
  • Metric: Institute regular reporting of important performance indicators. The first step is to determine the state of the accounts receivable as well as the productivity of RCM. Follow-up with regular reports to demonstrate progress during the course of engagement. Assess the effectiveness of team members as well as what their contribution to the collection of receivables. Review the overall company RCM performance during monthly meetings for management consultation together with Skytale. Skytale team.

Are you a business owner with an interest in growth? We've created an entire team that has the right knowledge and experience to assist your company get the direction it wants to take. Contact us now!

If you're searching for ways to expand your DSO take a look at how you can enhance the experience for patients.

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