Deliverables
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Comprehensive Readiness Assessment
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Accreditation & Certification Roadmap
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Change and Quality Management Support
Challenge
The client, a national Dental Service Organization (DSO), encountered revenue cycle data management challenges that created inefficiencies during insurance verification, case presentation, claim submission, payment posting, AR management and patient collections. The objective was to address duplicative data, out of date contracted and UCR fee schedules and communication challenges between enterprise and practice teams to reduce discrepancies between collected and contracted fees, improve opportunities for revenue capture and more closely align with patient expectations for treatment costs during case presentation.
Solutions
ProspHire assessed existing revenue cycle data management structures across all affiliated orthodontic practices, including both the legacy practice management system and Planet DDS databases, to identify differences and similarities in how data was stored, entered, presented and submitted. A crosswalk was developed to map existing processes and fees by code to future codes and fees to plan database updates and closely manage all changes. ProspHire collaborated with DSO orthodontic and vendor teams to identify future state requirements in line with PMS guidelines to develop a data management strategy that would benefit both existing and newly affiliated practices. This multi-prong strategy optimized PMS utilities, automated systems, practice coordination and manual processes to provide a sustainable mechanism for the management of revenue cycle information. The team ultimately performed both a manual and automated database redesign using the updated workflows to provide the client a data structure to support both practice and enterprise teams during daily payment processing, posting and collecting.
Impact
ProspHire led the successful revenue cycle database cleansing and process alignment for over 50 orthodontic practices across a 3-month period via a collaborative partnership with DSO revenue cycle, operational, IT and credentialing enterprise teams. The updated database, including contracted payer and office fee schedules, improved revenue capture of complete contracted total dollar amounts, more accurate fees during case presentation with patients and downstream collection efforts with integrated third-party financial vendors. Streamlined processes improved the ability of the enterprise teams to partner with affiliated practice teams during the development and execution of financial arrangements and orthodontic contracts to meet patient needs throughout the course of treatment and in turn, DSO revenue goals and objectives.
