When a dental practice based in Washington reached out to Elevate to discuss dental billing and insurance verification services, it was not the first time this practice had opened a dialogue. The practice had considered using Elevate but ultimately opted for another company with a slightly lower collection percentage. However, the practice discovered that some of the promises made by that company were not being fulfilled, which required the doctor to engage in constant oversight of the dental billing partner. Typically, utilizing a dental billing partner saves both time and money, but in this case, the doctor’s attention was being split between her patients and managing the dental billing company.

Several factors further complicated the doctor’s situation. First, she had decided to move out-of-network from all dental insurances, but she still had outstanding claims tied to carriers. By moving out-of-network, she needed to understand what she should be collecting from her patients at time of service. She also wanted to help her patients get reimbursed through any benefits for which they might qualify. And lastly, she would need a patient portion dental billing solution to accommodate her new business model. Her existing dental billing company offered a version of these services, but in a more “one size fits all” format; she was in search of a modified set of solutions that could adapt as her practice evolved.

Elevate engaged a team comprised of sales, operations and business support leaders to evaluate this dental practice’s situation and collaborate on a sustainable and economically efficient solution. For example, the dentist thought she would require a complete breakdown to verify each existing patient based on that patient’s insurance, but her volume of patients was enormous. A project of that magnitude would likely be cost-prohibitive, given that complete breakdowns are typically reserved for new patients or patients with new insurance. Elevate recommended taking a different approach and conducting an insurance consolidation project for the dentist. This project would involve assessing up to 20 insurances that were most used by patients and determining fee schedules from that angle. This option fell within the dentist’s budget and would ultimately accomplish the same goal. Following the insurance consolidation, only new patients would require complete breakdowns and all existing patients would be tied to their respective carriers.

The dentist and the Elevate team also joined forces to develop an out-of-network dental billing solution to help the practice reimburse patients who paid upfront due to the practice’s new out-of-network status. In this situation, the practice would collect the fee for service from the patient, and Elevate would submit a claim on behalf of the patient for a flat monthly fee based on volume. If the patient was eligible for any reimbursement, the insurance would send the payment directly to the patient. This allowed the practice to provide a valuable service to its insured patients while also freeing the practice from the time-consuming task of managing any incoming insurance payments and distributing them to patients. Further, Elevate proposed a special project to work the aging that had accrued while the dentist was in-network, so she could get what she was owed from the insurance companies. Elevate would assess a percentage of the collections as its fee for this solution.

Finally, the dentist and the Elevate team worked together to develop a patient portion RCM solution that would both leverage the efficiencies of today’s technology and automation while maintaining a personal touch with patients, a high priority for the dentist.

The Elevate team is often asked why it does not publish pricing for its services, and this case is an ideal illustration of why. Only the individual practice owner can fully understand his or her financial needs and goals, which is why a customized approach is so critical to fulfilling those objectives. Through extensive collaboration and creativity, Elevate and this dentist were able to design the ideal suite of solutions for this practice, developed with the foresight that continued evaluation, growth and adaptability would be key aspects to the partnership.

Michelle Affanato of Affinity Management Consulting in Mansfield, Massachusetts is a longtime dental practice consultant. Michelle began her career chair-side in 1990 and moved into management-level roles in 2005. She has been guiding dental practices as a consultant for 13 years.

Based on her extensive experience and knowledge of the dental industry, Michelle has a keen understanding of what a practice requires to thrive financially. She also recognizes that the needs of a start-up practice are vastly different from those of an established office.

“Startups have to make sure all their information is correct from the beginning, from credentialing to fee schedules, because they won’t collect without accurate data,” says Michelle. “Establishing this foundation is incredibly time-consuming and these brand-new practices typically have a skeleton crew. These practices need a billing partner right away.”

Michelle also helps optimize performance for established dental practices. She asks the practice a series of questions, including detail on the current Accounts Receivable balance. She gives particular attention to the amount in the over-90 days category. She then investigates what process the practice is using for claims and collections management, how much the practice is spending on staffing for this particular set of tasks, and whether the process is being given sufficient attention and priority. She also considers the space required to have an internal team. Many practices have small offices without ample physical space to perform billing duties.

Having available physical and human resources on-site is not the only element necessary to properly manage a practice’s revenue cycle. The practice must have the right resources, meaning personnel with dental billing expertise. Navigating the complexities of dental insurance requires knowledge and experience in dentistry.

“If the office has the right personnel and there’s a reliable process in place to keep both A/R and costs low, then I recommend maintaining the current process and staff,” comments Michelle. “But in most cases, the practice does not have the bandwidth to give the billing process the attention it needs, and then I recommend outsourcing. Simply put, if you want your money, you outsource.”

One general dentistry practice Michelle represents in Winchester, Virginia had 30% outstanding claims rate in the over-90 category. Though the practice had a team member dedicated to working claims, the aging climbed because she wasn’t upholding her responsibilities related to managing the pending claims log and ensuring providers were credentialed. Add in a change to the practice’s clearinghouse, and it created the perfect storm.

Michelle’s response to the practice? “Don’t hire someone new. Instead, let’s find you an outsourcing partner who can clean this up for you and keep your A/R current.”

The practice chose Elevate, and in less than four months, the $100,000 in the over-90 account was reduced to just $10,000.

Michelle guided a Lathrop, California-based family dental practice to utilize Elevate as its dental billing partner. In this scenario, the financials in the practice’s dental software weren’t matching with its bank accounts. Michelle discovered this was a result of no payment postings for two months.

As Michelle notes, “It’s nearly impossible to catch up on an issue like this. If an account isn’t settled, the practice can’t collect any money owed by the patient. And if the practice can’t collect money, it will have to write off balances. Writing off balances means no income for the practice, which is not sustainable.”

When Elevate took on this practice, it was able to make signifiant improvements to aging in a very short period of time.

“In this case, I told the practice I wasn’t giving them a choice. You HAVE to hire this company to fix this.”

From Michelle’s perspective, dental billing is a full-time job, and depending on the size of the practice, two or more staff members may be necessary. Considering salary, benefits and time away from the practice for sick or vacation leave, outsourcing with a partner who is 100% dedicated to focusing only on revenue cycle management is typically more cost-efficient than having in-house billing. A dental billing partner like Elevate has an entire team dedicated to a practice; if one team member is out on leave, another team member fills in. That way, attention on claims and collections is constant.

Michelle has very specific views on what a billing partner should offer to dental practices. The first two questions she asks of a prospective dental billing partner is how comprehensive the service is and can it be customized. For example, one solutions provider may check benefits but won’t enter it into the practice’s software. Both tasks must be completed to be helpful to the practice. Every office is different, so the capacity to customize solutions for the practice and provide end-to-end service is crucial.

Communication is also a key to success. The billing team is comprised of the practice, the consultant and the dental billing partner. Everyone must be on the same page and willing to have regular dialogue and weekly or monthly update calls. A practice must consider its dental billing partner like an extension of its practice. For example, the billing partner must know if the practice goes out-of-network or has a new credentialing need, or if there is a material change to practice. All three entities must be in lock-step, and open lines of communication keep all parties apprised of the information necessary to provide optimal outcomes.

Michelle has referred numerous practices to Elevate Billing Solutions, and the relationship among consultant, practice and dental billing partner has proven successful time and again for two very specific reasons: Customization and Communication.

A general dentistry practice located in Waldorf, Maryland started service with Elevate in July 2022. At that time, the practice’s aging had soared to 35% of the total amount of its insurance collections and was continuing to trend in the wrong direction. In addition to managing all current collections, Elevate’s team mobilized to address the aging problem swiftly. In only a few months, the practice’s aging was reduced from 35% of total collections to 8%.

Why had this practice’s aging increased so dramatically? First, the practice had a lot of turnover at its front desk, which meant there were gaps of time when attention to collections was not adequate. High rates of turnover are a reality in our current economy, and they wreak havoc on a practice reliant on one person to handle dental billing and claims and collections management. Because the practice was challenged in finding someone with dental experience to manage the office, the dentist opted for a candidate with medical experience. While it would stand to reason that medical and dental experience would be comparable, dental insurance is an entirely different world to navigate, with complexities and nuance exclusive to dentistry. While this individual was hard working and reliable, the learning curve for dental proved to be insurmountable. Claims went unaddressed, payments were not properly posted, and reconciliation was lacking, all of which led to a massive uptick in claims sitting beyond 90 days. Even when the dentist was able to hire an experienced dental billing professional to manage claims and collections and stability was restored, it was only temporary as that individual left for a new opportunity.

At wit’s end, the dentist explored various options to address the growing concerns of increased aging and disruptions from turnover. It took an Elevate team comprised of experienced dental professionals who focused exclusively on the practice’s revenue cycle to turn things around. After suffering for so long, the practice finally saw its aging trend in the right direction, and it happened quickly. To help ensure timely collections resumed, the dentist worked directly with Elevate’s dedicated account lead until processes were smooth again.

The work is never done and constant attention must be paid to claims in every category, from current to those over 90 days. However, this substantial decrease in aging meant the practice was getting compensated for the patient care it was rendering, and its revenue became more stable. This dramatic reduction in aging occurred through outstanding teamwork and communication between the practice and Elevate as its dental billing partner. The practice was diligent in utilizing the Elevate Hub, the proprietary communication tool Elevate has developed to ensure its clients are up-to-date on all activity on their account. The Elevate team assigned to the practice met regularly with the office staff to review performance and outcomes and shift attention to the practice’s evolving priorities.

Today, the office is a “well-oiled machine” with aging at a reasonable and declining level and the right resources in place. The current situation is allowing the dentist to properly train her front desk personnel and give that effort the attention it deserves. Her stress and financial concerns have been alleviated because she has confidence and trust in Elevate’s performance, and there is less hiring pressure because her Elevate team has the right training to achieve the practice’s financial goals.