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Hi everyone and thank you for tuning
in to the Becker's Healthcare podcast.

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I am Ryan Mohammed, she her pronouns
with Becker's Hospital Review.

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Today I am absolutely pleased
to be joined by Cena Amiri,

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vice president of Revenue ATIs Cena.
Thank you so much for being here today.

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How are you?

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It is my pleasure, Maria.

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Kudos to you and your team for having
an outstanding publication that I read

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quite frequently.

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Yeah, of course. Thank
you so much for that.

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And with that we can jump right into
the first topic in our discussion today.

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So to start with some background,

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can you tell us what is revenue cycle
management in the healthcare industry and

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also what are the essential RCM
metrics that DSSO should monitor?

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So Maria, I'm a former D S O
operator. So prior to joining xis,

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I ran a private equity back D S o.

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And the way that I look at revenue cycle
management is that it's the financial

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circulatory system of a dental
support organization and

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any dental practice.

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And the revenue cycle begins when the
patient reaches out to schedule an

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appointment and it ends when all the
payments for that appointment and

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treatment have actually been collected.
And without revenue cycle management,

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dental practices would not be able to
stay in operation to treat patients,

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employ people, or frankly
pay their suppliers.

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And we believe at dentists that effective
revenue cycle management increases

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provider revenue while
decreasing the time that dentists

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spend on administrative
and nonclinical functions.

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And when you think about
it, right, what is A D S O?

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It's providing nonclinical
support services.

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So every D S O in the country
is there for a dental revenue

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cycle management organization.

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And to your second question with regards
to what are the metrics they should be

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looking at ATIs,

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we're looking at all
of your insurance KPIs,

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so all of the metrics
that relate to the payers.

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And when we look at the payer mix,

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what we're looking for is the
number of paid claim line items.

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We're looking at the
number of claim line items,

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we're looking at your average claim
denial rate across your existing payer

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mix.

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And we think it's really beneficial
to also know your denials by your top

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10 payers.

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So if you notice for example that
Delta Dental is contributing,

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you know, 35% of the 12 denial
volume to your organization,

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it's probably a payer you should pay more
closer attention to and really look at

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how you're submitting those
claims. And our platform,

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which is a software platform,

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does look at code level denials and we
think that the analysis of code level

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denials is a great metric to
look at on a frequent basis.

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Now on the insurance collection side,

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we look at the top payments
that are issued by payers.

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We look at how that breaks
down across your practices. Um,

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we're also looking at the method
in which those payments are issued.

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So it's no wonder that if you're relying,
let's say on check payments, right,

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you're relying on snail mail,

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those payments are gonna hit your bank
account probably a little bit later.

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We are big proponents of E F T
payments from payers and a lot of

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organizations and practices that we
come across are not actually set up

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to receive EF F T payments because a lot
of the payers require you to be set up

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on electronic remittance advice, um,

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in order to receive those E F T payments.

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So that's a analysis that we
generally do for organizations.

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And our goal basically is to ensure that
as soon as the payment is ready to be

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issued, you can, as a
provider organization,

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you can take that payment in
as as quickly as possible.

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And then you have your standard metrics
or KPIs like your average insurance AR

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days, your average collection ratio,

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as well as your lowest
collection ratio by payer.

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Wonderful. Yeah, thank you so
much for sharing that insight.

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The next question I wanted to ask
you, I feel like is very crucial. Um,

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so when should DS DSOs
consider centralizing or

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outsourcing key revenue management
functions like credentialing, um,

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insurance verification
and payment posting,

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and also how should they strategize
this approach as they scale their

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operations?

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Marie, when I look at this question,
I often start with, you know,

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what is the objective of your D S O?

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And you have to really
look at what is the current

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core competency of your organization.
I think before you can determine,

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you know, what needs to be
outsourced. So as an example,

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if you are going to your providers and
saying to them that when you join R

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D S O,

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one of the things that we take great
pride in is generating new patient flow,

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right? So marketing would then have to
be a core competency of your organization

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because you're promising
these affiliated practices,

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the fact that you're gonna drive new
patient traffic. On the other hand,

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if you're affiliating with practices
and your brand promise to those

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practices is that we're gonna
improve your AR and we're going to

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reduce your claim denials,

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then revenue cycle management should be
a core competency of the organization.

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Now what's interesting is
that in the medical industry,

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outsourcing revenue cycle management is
way more common than it is in dental.

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I think part of the challenge we have
in dental is that considering the fact

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that consolidation is a relatively
new phenomena versus medical,

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meaning the majority of the market
is still not consolidated into down

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groups, historically,

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there hasn't been a lot of
great outsourcing options

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available in the market. And so I
think a lot of the D S O operators,

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they're struggling with the quality of
the existing solutions in the market.

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You know, at Xis we look at it from
a perspective of if you wanted to,

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for example, outsource
your credentialing, um,

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you really look at what are the vendors
that are in the market and determine can

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they do a better job than
we can internally, right?

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With this particular process.
And I always recommend, you know,

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starting a pilot or a trial so that you
can actually assess the quality of the

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work that's gonna get done and then
you can decide whether you're going to

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expand, uh, the services from there.

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So I think it really comes down to
determining what is the brand promise to

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those providers and then determining
whether you have the existing resources or

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could you potentially
bring on those resources.

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And with the current
interest rate environment,

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I think that there is generally a
greater tendency today than let's say

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2020 or prior to outsource
certain functions

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because a lot of the
DSOs are challenged with

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justifying the increase in overhead
expenses at the corporate level,

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particularly if they have existing
bank debt and the um, predators, right,

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require you to have a certain ratio.

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Yeah,

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thank you so much for giving us those
examples and that background is really

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helpful and how we see what's
happening for DSOs right now. Um,

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for you,

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how can dental service providers enhance
the effectiveness of revenue cycle

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management, uh,

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by leveraging artificial intelligence
or AI and technologies like the robotic

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process automation?

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So there's a lot of buzzwords
Maria getting thrown around
in the industry today

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and you know, when we look
at, um, the trends, we,

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we generally look at what
problem you're looking to solve.

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And so I would caution everybody to,

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rather than getting on a hype train,

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really finding out what is the problem
we're fundamentally trying to solve.

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So one of the problems that exists today
in dental revenue cycle management is

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there was a lot of P D
F and paper documents.

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And so a sub-segment of
artificial intelligence,

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which is called text mining, it's also
referred to as text and analytics, um,

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used as natural language
processing to transform the free

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text in these documents and
databases into normalized

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structured data that's very suitable
for analysis by machine learning

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algorithms.

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This is an area that Xis specializes
in and the reason why we think it's

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super relative, um, to
providers is all of us,

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if you've ever been to a dental clinic,

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know we get a lot of mail
and when we don't get mail,

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we're logging into payer portals
and we're downloading such things as

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explanation of benefit statements.

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So we believe that text
mining is a very applicable

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segment of artificial intelligence
that every provider should leverage

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given the volume of P D F documents,

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physical documents that are
coming in to the practice, uh,

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and and a lot of data, right?

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Residing these documents that can
assist you in collecting more cash from

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payers.

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Yeah, absolutely. It all sounds
very effective and overall,

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you've given us some amazing answers
today. Thank you so much for that. Uh,

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but before I let you go,

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the last thing I wanted to ask you
is what sets a Z apart and uniquely

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positions it to assist DSOs with
their revenue cycle management needs?

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Uh, so Maria,

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we were founded in 2015 and
we're backed by Silicon Valley

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investors and we were the first to offer
a modern cloud-based insurance revenue

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cycle management software.

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And today we are privileged to
have over 40 of the fastest growing

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dental support organizations with
over a thousand dental practices using

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our software to reduce claim denials
and collect cash faster from payers.

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Um, what really sets us apart,

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I believe is the fact that we have today
the widest dental payer coverage in

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the industry.

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What I mean by that is today
we are parsing over 200,

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uh, unique payers explanation
and benefit statements.

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So our text mining technology can
extract relevant information from

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these EOBs across more than
200 payers. On top of that,

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we have the ability to aggregate
electronic remittance advice

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ERAS or 8 35 s across
more than 500 payers.

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So this coverage is by far
the greatest coverage of payer

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analysis in the industry and we think
we can bring a lot of value to DSOs that

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are national that have practices across
various states considering that we've

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already worked with a lot of these
payers already. Uh, on top of that,

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outside of the clearing houses,

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we have the largest AI ML
engineering team that's dedicated

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specifically to revenue cycle management.

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We are today the largest team that's
focused a hundred percent on insurance

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payment posting technology innovation.

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And so what I mean by that is we have
the ability to reconcile, for example,

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your remittance data,

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those EOBs and eras
against the check-in E F T

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deposits that are coming
into the bank account.

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And this eliminates the need for
manual EF f t trackers or lockbox

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services and is going to improve
the productivity of your insurance

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payment hosting team.

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Wow, that is absolutely amazing.

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Thank you so much Cena for your time
and a great dis discussion today.

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We really do appreciate it.

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It has been my pleasure, Maria, and uh,

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thank you so much for having me on
the Becker's Healthcare podcast.

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Yeah, absolutely.

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And I'd also like to thank Zest as
well for sponsoring this episode.

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You can tune in some more podcasts from
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