Dental Practice Management Workflow Redesign

Redesigning Revenue Cycle Workflows to Improve Collections, Efficiency and Practice Performance

Challenge

In 2022, following the pandemic, the client, a DSO, faced significant challenges with high turnover and decreased employee retention. Attracting qualified individuals was difficult amidst rising wage expectations. Moreover, the absence of SOP’s posed a substantial obstacle to effective onboarding of new team members. Prior to 2022, the organization struggled with inefficient benefit checks and lacked robust denial prevention and management protocols at both practice and enterprise levels. Consequently, by the end of 2022 the collections percentage of production had fallen to 91.2%.

Solution

Under the guidance of ProspHire’s Hootan Shahidi, who was a contractor at the time, a thorough analysis of PMS data was conducted to identify trends in collections-to-production ratios and potential network issues, especially after the DSO added 17 dental specialists in 2021. A playbook was created for benefit checks, electronic prior authorizations and claims submission. A new role, Senior Treatment Coordinator (STC), was introduced to manage larger treatment plans and prevent denials. The strategy also included educational seminars, automated processes in the custom PMS and ongoing support at the practice level. KPI’s were implemented across practices to drive accountability, incentivize success and address performance gaps.

Result

Hootan led the successful revamp of treatment presentation and revenue cycle management (RCM) processes for 15 practices over a 3-month period in 2022. This was achieved through a collaborative partnership with the DSO revenue cycle, operational, IT and credentialing teams. The objective was to enhance team member education, RCM processes and ensure accurate treatment plan presentations at the practice level. Systems were implemented to proactively add new practitioners to in-network insurance carriers, along with consistent education and training at the practice level to ensure accuracy in treatment plan presentations. By continuing these initiatives, the DSO has increased its collections-to-production percentage to approximately 96%, leading to a significant boost in EBITDA three years later.