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.