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Dental RCM Automation

I’ve had over 1,500 conversations with dental industry professionals since the start of the pandemic, ranging from a solo practice doctor to C-suite executives of national DSO’s. The most common theme: employee turnover and talent acquisition at the office level, specifically for front office and office manager roles. The data backs it up too. According to the ADA, roughly 40% of dental practices nationwide report having open positions and say they are looking to hire new staff members. Among practices with openings, 90% report it is extremely difficult to find workers. 

The result is that we are asking office staff to do more with less, at times compounding the turnover issue. I want to spend a few minutes detailing how you can leverage RCM technology in a way that produces a force multiplier effect. When deployed in a meaningful way, your staff can view RCM technology as a partner that improves job satisfaction and helps them focus on what matters – patient care. 

What can be automated?

I’m going to limit the scope of the conversation to insurance verifications. It’s one of the more dreadful tasks for office staff that eats up an inordinate amount of time. I routinely talk to offices and groups that have full-time employees (sometimes entire departments) whose sole jobs are to verify insurance benefits. These staff members typically spend around 4-6 hours of their day on the phone with insurance companies obtaining benefits breakdowns – and the other 2-4 hours maneuvering various insurance portals trying to get the same information. The primary result is an inefficient process largely driven by the insurance industry. The secondary result? How many of your staff members currently tasked with this would say they enjoy this part of their day? It’s not a recipe for employee retention and I imagine it’s difficult to find candidates chomping at the bit to do this all day. 

The other challenge being maintaining a level of timeliness and accuracy around this task. With recent turnover rates, we often have team members managing the verification process without adequate training or investment in the accuracy of the information retrieved. Unfortunately this, as we know, has a negative impact on our claims process down the line.

Potential Solution 1 – Call Center Outsourcing

The first thing many practices try is to outsource the entire verification process. For some, this is the ideal solution. The third party takes over the hassle of logging into portals, making phone calls to payers and updating the practice management system. The group has successfully taken the task off their team’s plate, making it a non-factor for employee turnover and talent acquisition. There are a couple of downstream concerns to be aware of when outsourcing.

  1. Accuracy – one of the most common issues I hear from groups transitioning away from outsourcing is accuracy of the data being put back into the system. When presenting a treatment plan worth thousands of dollars to a patient (and the practice), accuracy is kind of a big deal. Outsourcing insurance verifications isn’t solving any of the underlying problems of it being a highly manual (inefficient) process. It’s simply outsourcing the accountability to an unknown quantity at the risk of thousands of dollars.
  2. Cost – for those groups that have a fantastic call center partner that is highly accurate and timely, it’s equally as much of a cost center in my experience. Group practice dentistry was founded on the idea that we can leverage economies of scale while maintaining excellent patient care. With a cost structure that is based on a per verification charge, there are no economies of scale that can be leveraged outside of heavy-handed negotiating. 

So in order to improve on the outsourcing solution, we need a solution that addresses the accuracy concern and one that provides for economies of scale that can be leveraged for increased profitability.

Potential Solution 2 – Technology Based Automated Insurance Verifications

RCM technology has improved leaps and bounds over the past few years that allows for game-changing automation with insurance verifications. In the time it takes to call an insurance company, request a fax-back, obtain the fax-back, and scan it to the patient’s file – software can now automate that process for your entire schedule, verifying eligibility and obtaining benefits breakdowns in real-time. In essence, a task that we previously measured in hours can now be measured in seconds or minutes. Your staff can walk into the office each day with their schedule already verified and benefits breakdowns automatically uploaded to the patient’s file. Automated insurance verifications done ahead of time, or in real-time.

Software also allows us to address the accuracy and cost concerns of a call center. Via integrations with the practice management system and insurance payers, human involvement in obtaining this data has been drastically reduced, providing for near 100% accuracy. Additionally, software was built for economies of scale, allowing groups to tap the profitability side of this equation. The cost of running each additional verification is negligible compared to a human being from a call center obtaining the data.

What’s the real-world impact of this automation? Right now it’s producing an average time savings of around 70% on the task of insurance verification for RCM teams across the country. Each month the time savings impact is increasing as a result of technology improvements. The RCM teams that I see with a competitive advantage have become experts at partnering with technology to let it maximize their human capital resources. They’ve mastered the concept of return on time, shifting resources from verifying insurance to patient care (or other revenue driving activities). 

The Battle for Talent

Now let’s tie this back to employee retention and talent acquisition. RCM teams that can help their employees spend more time on patient care and less time chasing down fax-backs will win the battles on employee retention and talent acquisition. We hear that there are more meaningful tasks they’d like to see their teams spending time on anyways. Where would you like to see your team focusing their extra time while not on the phone with insurance companies this year? 

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