One of Elevate’s dental billing team members should be called the “fixer,” though some might argue that “magician” is more appropriate. She is a recognized expert at cleaning up accounts receivable that have built up over time due to a practice having challenges hiring and retaining skilled employees or simply not having the bandwidth to give adequate attention to the dental billing process. When dental billing isn’t placed at a high priority in a practice, the outcome is inevitable: Aging will increase. And the longer the practice is distracted by other tasks, the worse it gets.

These situations create financial pressure and undue stress for a dental practice, and the only real solution is bringing on a dental billing partner to invest the same care in managing the practice’s revenue cycle as the dentist gives to his or her patients. The fixer gets excited when she’s handed an aging mess.

“It’s like a giant puzzle that’s fun to solve. I love my job so much, especially when it involves working on aging,” says the fixer. “Bringing the outstanding claims rate to 0% is an achievement that brings me great satisfaction.”

One of the fixer’s great puzzles was a general dentistry practice located in Los Gatos, California. This practice had employed two individuals to manage dental billing in-house, one who worked at the physical office and the other who was remote. When both the individuals left for other opportunities, it was discovered, among other things, that insurance data had not been entered correctly in the software and there were extensive duplicates.

“In order to clean up the situation, you basically have to unhook all the insurances that are tied to employer benefit plans and to individual patients,” explains the fixer. “It’s a three-step process just to eliminate one duplicate insurance.”

This insurance problem was one of several contributing to the high level of claims sitting in all categories. A third of the practice’s overall receivables were in the over-90 day column, and 53% of all reimbursements owed to the practice were beyond 30 days.

When the practice chose Elevate as its dental billing partner, Elevate deployed a team of billing professionals to assess the financial activities of the practice in their entirety. This is standard operating procedure for Elevate, which provides many practice management services beyond its core billing and insurance verification solutions. By conducting a comprehensive assessment of the practice, Elevate is able to counsel the practice on the various ways it might improve its profitability.

In additional to billing and insurance verification services, the Los Gatos practice contracted with Elevate to conduct a special project to address the inaccurate insurance data in the software. In this particular situation, Elevate decided the fixer was the perfect choice to manage the project, and she proved the company right. In only three months, the fixer was responsible for a heroic feat, cleaning up all the aging and restoring profitability to the practice. She accomplished this by overseeing a massive insurance consolidation project as well as establishing new processes to address outstanding claims. Today, this practice has a 0% outstanding claims rate, a dramatic improvement from the original 53%.

How was the fixer able to create this exceptional outcome? “The key is working together as a team. I had to get to know the practice’s staff, and we had to open up lines of communication and truly understand everyone’s roles,” says the fixer. “This office was extremely responsive to my requests, and the sooner I had the information I needed, the faster I could fix their aging.”

The fixer also had great success with a general and cosmetic dentistry practice in Birmingham, Alabama. In this situation, the front desk personnel were hard working but didn’t understand the complexities of dental insurance. Dental insurance requires extensive justification for a claim, and notes need to be written in a specific way in order for a claim to be considered. Thus, a keen understanding of the entire process and all of its intricacies is the only way to get paid. This practice’s lack of dental billing experience, despite great intentions, led to the over-90 aging category reaching $47,000. In just 90 days, the fixer was able to reduce the $47,000 to a single claim of $995.

“Dental practices tend to be small and there is a lot of personal interaction with office staff and patients,” remarks the fixer. “Being comfortable with outsourcing partners is critical to the success of the relationship, and the results we’ve achieved have been due to the team perspective we’ve all shared.”

What’s the “secret sauce” for bringing a dental practice’s outstanding claims rate to 0%? According to the fixer, a commitment to teamwork and clear and open communication will always lead to optimal outcomes. When all people and processes are working together in sync, success is inevitable.

Will your dental practice be the next puzzle for the fixer to solve?

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.

One of the chief complaints from dental practices today is the overwhelming task of managing billing processes. Challenges associated with dental billing can lead to reduced income, and even more problematic, a decline in quality of life for the provider and staff. Engaging the right dental billing partner for your practice can help restore sanity to your staff and yourself.

The right dental billing partner will:

Be your partner, working behind the scenes quickly and quietly to accomplish the tasks at hand.

Help you reduce your risk of embezzlement by staff while stabilizing revenue.

Link your success with theirs, such that there is a financial incentive integrated into the partnership to motivate the biller to collect every available cent for you.

Alleviate human resource pressures and reduce your practice’s personnel footprint, which typically results in immediate savings.

Have the right technology and a complementary commitment to advancing innovation, to reduce stress and hassle while providing improved financial outcomes to your practice.

Offer you certain promises and options for guarantees to improve your practice’s financial health.

Free you of financial worries through special financing opportunities, like Elevate Pre-Funding, secured by your account.

Asking the right questions is critically important when considering a new dental billing partner. These questions will guide you in vetting the billing company, to ensure you receive quality services that meet the specific needs of your practice.

1.  Are specific metrics utilized to assess the performance of the dental billing partner? If so, what data is tracked and how is it reported?

2. How and when will the dental billing partner communicate with your practice? What type(s) of information will be delivered through those communications?

3. How is the billing partner’s company structured and what support team and resources will be deployed to your practice?

4. What steps will the dental billing partner take to deliver service, and why are those steps optimal relative to other options in the market?

5. What examples can the dental billing partner provide to demonstrate how they have historically provided
exceptional outcomes? Do they have reviews, endorsements, and/or current clients willing to share their experiences with you?

Every practice is unique, and as the practice owner, you have distinct goals and objectives aligned with your short and long-term growth plan. Taking the time to ask the right questions will help you identify the best partner to support your dental billing processes and improve the financial position of your practice.

When you decide it’s time to identify a new dental billing partner, the options can seem endless and overwhelming. Taking these steps will make your selection process more productive and efficient and help you identify the right partner for your practice.

Step 1: Understand and communicate your goals to prospective billing partners.

Step 2: Secure recommendations from industry colleagues and ask for the rationale behind the recommendation.

Step 3: Identify billing partners that can show evidence of performance and are financially stable.

Step 4: Speak directly with the company’s operations and billing personnel.

Undergoing a diligent and thoughtful assessment of a prospective billing partner is a worthy investment of time and energy. Taking an investigative approach is the best measure to ensure your partnership is successful.

The expert leadership team at Elevate Billing Solutions by Nobility has a long-standing history of innovating revenue cycle management solutions for medical and dental practices of all sizes. These experienced individuals are recognized in the industry for their prowess in achieving metrics-driven outcomes for Elevate clients. This article highlights some key advice from company leaders, ranging from the questions you should ask when evaluating a partnership with a dental billing company to your financing options as you grow your dental practice.

The 5 Most Important Questions You Should Ask a Prospective Billing Partner – Dr. Michael Fossum, CEO

When a dental practice decides to partner with a new billing service provider, there are typically one of three overarching reasons for the change: (1) the client’s hair is proverbially on fire due to ongoing crises with the current dental biller, resulting in the practice experiencing a significant decline in its financial health; (2) the client is so inspired by the value proposition of the new dental billing service provider, it’s unquestionably worth making the transition; or (3) the dental billing process has simply become too overwhelming for office staff to adequately manage, and a billing partner is the next natural step to alleviating those back office pressures. 

Regardless of which scenario applies, it is critically important to ask the right questions when considering a new dental billing partner. Using these questions as your guide for vetting the billing company will help to ensure you receive quality services that meet the specific needs of your practice.

1. Are specific metrics utilized to assess the performance of the dental billing partner? If so, what data is tracked and how is it reported?
2. How and when will the dental billing partner communicate with your practice? What type(s) of information will be delivered through those communications?
3. How is the billing partner’s company structured and what support team and resources will be deployed to your practice?
4. What steps will the dental billing partner take to deliver service, and why are those steps optimal relative to other options in the market?
5. What examples can the dental billing partner provide to demonstrate how they have historically provided exceptional outcomes? Do they have reviews, endorsements, and/or current clients willing to share their experiences with you?

Every practice is unique, and as the practice owner, you have distinct goals and objectives aligned with your short and long-term growth plan. Taking the time to ask the right questions will help you identify the best partner to support your dental billing processes and improve the financial position of your practice.

Four Steps You Should Take When Choosing a Billing Partner – Brian Flynn, VP, Business Development

When you decide it’s time to identify a new billing partner, the options can seem endless and overwhelming. But a “one size fits all” solution rarely leads to ideal outcomes because dental billing needs can be sensitive, and providers have diverse priorities influenced by the practice’s size, scope and stage of its own life cycle. 

Before considering a new dental billing partner, taking a few critical steps can help to ensure the process is productive and the final selection is one that benefits all parties involved.

Step 1: Understand and communicate your goals to prospective billing partners.

The best way for a dental billing partner to customize its solution for your practice is to first understand your specific goals and objectives. What kind of HR footprint does your practice have? What elements of the billing process challenge you most? What are you ultimately wanting to accomplish with your dental billing partner? 

Step 2: Secure recommendations from industry colleagues and ask for the rationale behind the recommendation.

Your peers often face the same challenges as you, so if they are satisfied – or better yet, ecstatic – with their dental billing partner, this partner may provide services that also align with your goals. But it’s not enough to simply ask for the name of a company; the most important question you can ask is, “Why are you recommending this billing partner?” Putting the “why” behind the endorsement gives you context and proof of performance.

Step 3: Identify billing partners that can show evidence of performance and are financially stable. 

Financial stability is a crucial factor because the billing partner you choose will be managing your revenue. If the biller isn’t financial healthy, it stands to reason that the service it provides to you won’t improve your financial position either. Dental billing partners able to demonstrate a long-term commitment to remaining in the market will promote continuity for your practice, and those that can produce data to showcase performance – essentially walking their talk – will likely be a stronger and more valued partner for you, now and in the future. 

Step 4: Speak directly with the company’s operations and billing personnel.

A dental billing partner should be a natural extension of your practice. When assessing if a billing partner is the right fit for your existing staff and your specific needs, you can get a much better sense of how your respective organizations will interface by opening the lines of communication to all stakeholders on the front end. This dialogue enables you to find out what the dental billing partner’s contingency plans might be to ensure there’s no disruption to the work on your account, get a preliminary glance into the communication style of the billing partner, and gain intelligence on other tangible and intangible dynamics.

Though the process can be time-consuming, undergoing a diligent and thoughtful assessment of a prospective billing partner is a worthy investment. Taking an investigative approach is the best measure to ensure your partnership is successful.

How the Right Billing Partner Can Change Your Practice and Your Life – Faisal Bhatti, VP, Revenue Cycle Operations

One of the chief complaints from dental practices today is the overwhelming task of managing billing processes. Smaller practices are struggling with the time it takes to adequately handle these processes, and they often lack the technological support necessary to automate billing activities. In most cases, larger practices have already engaged a billing partner to assist with insurance collections. However, many have billing partners that are not providing the promised value or efficiency, or causing the practice even more hassles than when billing was managed in-house. All of these challenges ultimately lead to reduced income, and even more problematic, a decline in quality of life for the provider and staff.

When you engage the right dental biller for your practice, you can restore some sanity to your staff and yourself. The right dental biller should be able to offer you certain promises; without those commitments, you won’t be guaranteed improvement.

The right biller should be your partner, working behind the scenes quickly and quietly to accomplish the tasks at hand. This means less time spent on billing-related tasks by you and your staff and more time to focus on delivery of patient care. Because of the contracted relationship with a dental billing partner and the accountability inherently tied to it, your practice can reduce its risk of embezzlement by staff while stabilizing revenue. The right dental biller will link your success with theirs, such that there is a financial incentive integrated into the partnership to motivate the biller to collect every available cent for you. 

In addition to optimizing revenue, the dental billing partner can alleviate human resource pressures and reduce your practice’s personnel footprint, which typically results in immediate savings. A biller with the right technology and a complementary commitment to advancing innovation will reduce stress and hassle while providing improved financial outcomes to your practice. 

Finally, the right dental billing partner can free you of financial worries through special financing opportunities secured by your account. For example, Elevate Billing Solutions by Nobility is the only billing provider that offers Pre-Funding. With this model offered exclusively to qualifying Nobility clients, the company pays the practice’s claims upfront and then collects from the insurance companies on the practice’s behalf. Pre-Funding enables the provider to have 100% predictable revenue, which, in turn, creates true financial freedom, now and in the future.

Financing 101: Factoring, Operating Lines of Credit and Pre-Funding – Dr. Michael Fossum, CEO

When assessing potential billing and revenue cycle management (RCM) partners for your dental practice, understanding the additional services or enhancements a prospective partner can deliver is nearly as important as the billing solution itself. Since your RCM partner should be an extension of your dental practice, having the opportunity to align that partner with your other priorities will undoubtedly improve efficiencies and outcomes. For example, is your RCM partner willing to invest in your future by offering methods to infuse capital into your practice? Access to capital directly influences your current stability and your long-term financial health, so who better to provide financing than the partner managing your revenue cycle?

Financing options available to today’s practices can seem as complex and nebulous as navigating the massive index of insurance reimbursement codes. The right RCM partner should have the expertise to provide both transparency and clarity, so you can feel confident in the financial decisions you make.

Financing comes in numerous forms, and a common one is factoring. In simple terms, factoring is selling your Accounts Receivable (A/R) at a discount to a third party. Sometimes, the A/R will be used as collateral for a loan, and an interest rate will be assessed on the accompanying loan. The discount or interest rate, depending on the structure, is essentially the fee for getting cash sooner rather than waiting for patients or insurance companies to pay. Also, the factoring company will likely handle collections on invoices, which may reduce time and expenses for your office. However, this structure also separates you from interaction with your patients regarding collections, which could have an adverse effect on your relationships.

Another frequently used financing tool is an operating line of credit. Operating lines of credit can be secured through banks and other financial institutions or through private entities. In some cases, the RCM partner will provide financing for operating and expansion capital. Nobility’s Easy Credit program is an example of this type of financing. With Easy Credit, Nobility offers a competitive interest rate to a pre-approved client, and that client’s A/R is used as the primary collateral.

Pre-Funding is yet another option, though this program is exclusive to Nobility clients. With Pre-Funding, Nobility pays a client’s claims upfront at a predetermined rate and collects from insurance companies afterward. Unlike other financing tools, no personal guarantee is required with Pre-Funding. This provides the client with 100% predictable revenue, month after month, to more effectively manage cash flow. 

Your growth objectives will inform much of your financing decisions, but don’t assume you must take the traditional bank route to get the capital you need. An innovative and creative RCM partner can be your gateway to financial stability and freedom in all aspects of your dental practice.