Hi everyone and thank you for tuning in to the Becker's Healthcare podcast.
I am Ryan Mohammed, she her pronouns with Becker's Hospital Review.
Today I am absolutely pleased to be joined by Cena Amiri,
vice president of Revenue ATIs Cena. Thank you so much for being here today.
How are you?
It is my pleasure, Maria.
Kudos to you and your team for having an outstanding publication that I read
quite frequently.
Yeah, of course. Thank you so much for that.
And with that we can jump right into the first topic in our discussion today.
So to start with some background,
can you tell us what is revenue cycle management in the healthcare industry and
also what are the essential RCM metrics that DSSO should monitor?
So Maria, I'm a former D S O operator. So prior to joining xis,
I ran a private equity back D S o.
And the way that I look at revenue cycle management is that it's the financial
circulatory system of a dental support organization and
any dental practice.
And the revenue cycle begins when the patient reaches out to schedule an
appointment and it ends when all the payments for that appointment and
treatment have actually been collected. And without revenue cycle management,
dental practices would not be able to stay in operation to treat patients,
employ people, or frankly pay their suppliers.
And we believe at dentists that effective revenue cycle management increases
provider revenue while decreasing the time that dentists
spend on administrative and nonclinical functions.
And when you think about it, right, what is A D S O?
It's providing nonclinical support services.
So every D S O in the country is there for a dental revenue
cycle management organization.
And to your second question with regards to what are the metrics they should be
looking at ATIs,
we're looking at all of your insurance KPIs,
so all of the metrics that relate to the payers.
And when we look at the payer mix,
what we're looking for is the number of paid claim line items.
We're looking at the number of claim line items,
we're looking at your average claim denial rate across your existing payer
mix.
And we think it's really beneficial to also know your denials by your top
10 payers.
So if you notice for example that Delta Dental is contributing,
you know, 35% of the 12 denial volume to your organization,
it's probably a payer you should pay more closer attention to and really look at
how you're submitting those claims. And our platform,
which is a software platform,
does look at code level denials and we think that the analysis of code level
denials is a great metric to look at on a frequent basis.
Now on the insurance collection side,
we look at the top payments that are issued by payers.
We look at how that breaks down across your practices. Um,
we're also looking at the method in which those payments are issued.
So it's no wonder that if you're relying, let's say on check payments, right,
you're relying on snail mail,
those payments are gonna hit your bank account probably a little bit later.
We are big proponents of E F T payments from payers and a lot of
organizations and practices that we come across are not actually set up
to receive EF F T payments because a lot of the payers require you to be set up
on electronic remittance advice, um,
in order to receive those E F T payments.
So that's a analysis that we generally do for organizations.
And our goal basically is to ensure that as soon as the payment is ready to be
issued, you can, as a provider organization,
you can take that payment in as as quickly as possible.
And then you have your standard metrics or KPIs like your average insurance AR
days, your average collection ratio,
as well as your lowest collection ratio by payer.
Wonderful. Yeah, thank you so much for sharing that insight.
The next question I wanted to ask you, I feel like is very crucial. Um,
so when should DS DSOs consider centralizing or
outsourcing key revenue management functions like credentialing, um,
insurance verification and payment posting,
and also how should they strategize this approach as they scale their
operations?
Marie, when I look at this question, I often start with, you know,
what is the objective of your D S O?
And you have to really look at what is the current
core competency of your organization. I think before you can determine,
you know, what needs to be outsourced. So as an example,
if you are going to your providers and saying to them that when you join R
D S O,
one of the things that we take great pride in is generating new patient flow,
right? So marketing would then have to be a core competency of your organization
because you're promising these affiliated practices,
the fact that you're gonna drive new patient traffic. On the other hand,
if you're affiliating with practices and your brand promise to those
practices is that we're gonna improve your AR and we're going to
reduce your claim denials,
then revenue cycle management should be a core competency of the organization.
Now what's interesting is that in the medical industry,
outsourcing revenue cycle management is way more common than it is in dental.
I think part of the challenge we have in dental is that considering the fact
that consolidation is a relatively new phenomena versus medical,
meaning the majority of the market is still not consolidated into down
groups, historically,
there hasn't been a lot of great outsourcing options
available in the market. And so I think a lot of the D S O operators,
they're struggling with the quality of the existing solutions in the market.
You know, at Xis we look at it from a perspective of if you wanted to,
for example, outsource your credentialing, um,
you really look at what are the vendors that are in the market and determine can
they do a better job than we can internally, right?
With this particular process. And I always recommend, you know,
starting a pilot or a trial so that you can actually assess the quality of the
work that's gonna get done and then you can decide whether you're going to
expand, uh, the services from there.
So I think it really comes down to determining what is the brand promise to
those providers and then determining whether you have the existing resources or
could you potentially bring on those resources.
And with the current interest rate environment,
I think that there is generally a greater tendency today than let's say
2020 or prior to outsource certain functions
because a lot of the DSOs are challenged with
justifying the increase in overhead expenses at the corporate level,
particularly if they have existing bank debt and the um, predators, right,
require you to have a certain ratio.
Yeah,
thank you so much for giving us those examples and that background is really
helpful and how we see what's happening for DSOs right now. Um,
for you,
how can dental service providers enhance the effectiveness of revenue cycle
management, uh,
by leveraging artificial intelligence or AI and technologies like the robotic
process automation?
So there's a lot of buzzwords Maria getting thrown around in the industry today
and you know, when we look at, um, the trends, we,
we generally look at what problem you're looking to solve.
And so I would caution everybody to,
rather than getting on a hype train,
really finding out what is the problem we're fundamentally trying to solve.
So one of the problems that exists today in dental revenue cycle management is
there was a lot of P D F and paper documents.
And so a sub-segment of artificial intelligence,
which is called text mining, it's also referred to as text and analytics, um,
used as natural language processing to transform the free
text in these documents and databases into normalized
structured data that's very suitable for analysis by machine learning
algorithms.
This is an area that Xis specializes in and the reason why we think it's
super relative, um, to providers is all of us,
if you've ever been to a dental clinic,
know we get a lot of mail and when we don't get mail,
we're logging into payer portals and we're downloading such things as
explanation of benefit statements.
So we believe that text mining is a very applicable
segment of artificial intelligence that every provider should leverage
given the volume of P D F documents,
physical documents that are coming in to the practice, uh,
and and a lot of data, right?
Residing these documents that can assist you in collecting more cash from
payers.
Yeah, absolutely. It all sounds very effective and overall,
you've given us some amazing answers today. Thank you so much for that. Uh,
but before I let you go,
the last thing I wanted to ask you is what sets a Z apart and uniquely
positions it to assist DSOs with their revenue cycle management needs?
Uh, so Maria,
we were founded in 2015 and we're backed by Silicon Valley
investors and we were the first to offer a modern cloud-based insurance revenue
cycle management software.
And today we are privileged to have over 40 of the fastest growing
dental support organizations with over a thousand dental practices using
our software to reduce claim denials and collect cash faster from payers.
Um, what really sets us apart,
I believe is the fact that we have today the widest dental payer coverage in
the industry.
What I mean by that is today we are parsing over 200,
uh, unique payers explanation and benefit statements.
So our text mining technology can extract relevant information from
these EOBs across more than 200 payers. On top of that,
we have the ability to aggregate electronic remittance advice
ERAS or 8 35 s across more than 500 payers.
So this coverage is by far the greatest coverage of payer
analysis in the industry and we think we can bring a lot of value to DSOs that
are national that have practices across various states considering that we've
already worked with a lot of these payers already. Uh, on top of that,
outside of the clearing houses,
we have the largest AI ML engineering team that's dedicated
specifically to revenue cycle management.
We are today the largest team that's focused a hundred percent on insurance
payment posting technology innovation.
And so what I mean by that is we have the ability to reconcile, for example,
your remittance data,
those EOBs and eras against the check-in E F T
deposits that are coming into the bank account.
And this eliminates the need for manual EF f t trackers or lockbox
services and is going to improve the productivity of your insurance
payment hosting team.
Wow, that is absolutely amazing.
Thank you so much Cena for your time and a great dis discussion today.
We really do appreciate it.
It has been my pleasure, Maria, and uh,
thank you so much for having me on the Becker's Healthcare podcast.
Yeah, absolutely.
And I'd also like to thank Zest as well for sponsoring this episode.
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