"The Devil's in the Details" - How Dentists Can Get Paid Faster (and What They Deserve) (feat. Monica Cappelli)

Monica Capelli, founder and CEO of Rev Systems, discusses revenue cycle management for dental practices in Episode 20 of "The Dental Domination Podcast." From the importance of claim filing best practices to pursuing outstanding claims, implementing pre-payment systems, and everything in between, Monica provides a roadmap you can implement in your dental practice to get paid faster — and get the money you deserve! Don't miss this episode — a must-listen for any dentist owner looking to improve revenue cycle management and build a more profitable practice.

Key Takeaways

• Collecting correct patient demographics and conducting detailed verifications are essential for getting paid consistently.
• Filing claims cleanly and including attachments and notes the first time around can prevent delays and denials.
• Implementing pre-payment systems, such as capturing credit card data, can help stop the bleeding on accounts receivable.
• Outsourcing revenue cycle management can be more cost-effective and efficient for dental practices.
• Symptoms that indicate a need for improved revenue cycle management include low collections compared to production, dissatisfaction among associates, and a lack of trained team members.

Transcript

0:01

All right, welcome back to the Dental Domination Podcast. My name is Dan Brian, I'm the co -founder at DentalScapes scapes we're an online marketing agency for dental practices specifically. But today I'm not here to talk about any of that. I'm here to spend some time with a very special guest. have today, Monica Capelli. She is the founder and CEO of Rev Systems, really focused on revenue cycle management for dental practices and healthcare practices, specifically. But I want to talk today about some topics that I'm, pretty sure that most dentists listening to the show might find interesting. So claim filing best practices, pursuing outstanding claims, and this is an interesting one, Monica, that I want to pick your brain on here a little bit. Pre -payment to stop the bleeding. I think that's something that everyone has maybe spent some time thinking about, but maybe is a little bit too afraid to poke the bear on, so to speak. But let's get into it here. So if you don't mind, Monica, could you just share a few things? about yourself and what got you into this and you're a former dental practice manager is that right? Okay awesome so how'd you get Well, I'm married to a dentist for 37 and a half years. And one of the things I noticed in managing my husband's practice, and at one point we had two, but I noticed that insurance was the bear. It's the bear in the room that no dentist wants to address. Most of the time, the front desk is handling it and the dentist has little to any degree firm grasp on the numbers. They may know, the revenue doesn't look like it should, but they don't know firmly what's going on, where's my pay. And when we start running reports, when I took over as his office manager, one of the first reports I ran was the outstanding insurance report. And it can be really eye -opening and a lot of practices won't run that. But once you do and you start to dig into those numbers, there's room for improvement. So over the years I developed systems to improve and reduce those numbers and get the dentist paid. And then I began marketing it and then I formed my company and here I am. safe to say most clients you deal with, look at those numbers the first time and it's pretty scary. Yeah. It's crazy. Yeah, it's crazy. So, you know, your company rev systems, you talk about, elevating clients, building practices and ensuring that that practices get paid faster. So what do you mean by that? And how do you go about doing that? What's sort of the bread and butter of your business? Sure, I'd love to explain it because I nerd on this stuff. And if I get too detailed, stop me, okay? That's what I love to do. But we start off with our full service. We start off with the claims audit, which means our experts will just go through up to 24 months of claims and find any of them that are still payable that are outstanding. And then we begin to reprocess those claims through appeals processes or whatever is required. We literally contact every insurance company by phone. We don't just go to the portals because you don't always get the full details. And we ask specifically, what do we need to do to get this claim paid? And then we make sure we meet their criteria. So we have a really good system for just finding the outstanding claims. That's the side that you've already missed, but there's also things that we can do on the front end to keep that pile from growing in the future. So we wanna stop the bleeding on the AR by implementing really great systems for everything from verification through claims filing and patient collections, et cetera. Yeah, 100%. And I want to get into that that prepayment that you talked about to stop the bleeding before we go there though. You know, like you said, a lot of practice owners, a lot of dentists, they may not be as deep into the reporting and into the weeds as maybe they should you know, quite honestly, dentists, you can't blame them. My husband didn't go to school, to, to, learn how to run a business. learned how to be a clinician and, and, know, we talk about marketing a lot on this podcast and how dental schools certainly don't prepare dentists to market their practices or, really, you know, own a business, you know, so to speak, but they're really not giving them much in the way of preparation to manage the finances. And so, When you talk about claim filing best practices, let's boil it down to basics here. What are some of the best practices that you really focus in on and recommend that practices implement in order to make sure that they're getting the revenue that they deserve? Yeah, there's a couple of key areas that you just have to have. You have to get right if you want to get paid consistently. One of them, first and foremost for me, is making sure you're collecting the correct demographics on the patients. A simple transposition of the birth date, the name spelled incorrectly, anything like that can cause the insurance company to reject the claim. Something that basic sounds like we shouldn't have to mention it, but you especially because some people will use like their middle initial versus their middle name and you know all these things. So first and foremost make sure every demographic that you enter into the database is correct. Second, when you go to do those verifications now, you get really detailed verifications. And most of the time people tend to verify about 40 or so, 40, 45 kind of basic codes that you want to verify. But what I find is the devil's in the details. And it's nice that those are the only codes you do, but some dentists like to make sure they're getting the ortho. Some dentists want to do night guards, things that aren't on the standard verification where you just run into an insurance portal. So if you have any kind of customized specialties in your office that you know you're going to want to talk to your patients about, you want to make sure you get that upfront in the original verification. I also like to do a follow -up verification because the ones who your verification is fine for most patients. However, there's going to be those patients that you just did a crown on, submit the claim and it comes back, they're out of benefits. Why? Because we didn't re -verify just before they got that crown and they had gone somewhere else and used some of their benefits or they didn't report a frequency limitation that the insurance company knows. So there's all those different kinds of little nuances that can cause a hang up in payment. So what we do and what I highly recommend if you have the in -house team to do is at least two days, sometimes three days before the appointment, verify code by code for everything that's on the restorative side of the schedule. And even periodontal and up, would say, because periodontal is another one where there may be out of pocket expenses and there could be, you know, funky limitations on. And if you do that in advance, if there's any anomaly, then you have time to call the patient ahead of time before their appointment and get that handled. That's that I say, verifications, people poo poo and they think I'm going to push a button and get an electronic verification. To me, that's where your revenue lives. Really? So I don't want to many practices, you what percent of practices that approach you for service are already doing that? I can't imagine it's that high that are paying, you know, that much attention or doing it, like you said in advance, two or three days before the appointment. What percentage of practices would you guess are doing? Yeah. Yeah. Yeah. And for you, you know, you've seen that you said that can be a pretty big game changer. It's a huge game changer, yes. And the other thing is to making sure that the claims are filed in a timely manner. Whenever I do those audits, I find unfiled claims galore, which most patients, I had one practice recently that I picked up a few months ago, 41 % of their claims, Did you just see my eyes go crazy? Yeah, they were submitting all of the, you know, hygiene claims were going without a flaw, but most of the restorative claims, if there was anything that needed any kind of attachment, any kind, they were just submitting everything. And if your software stops you for attachments and stuff and nobody goes back and fixes it, yeah, you're, it's a lot of money on the table. Yeah, so and to that that point because I'm just you know, I guess I'm a gossip. What's the what's the the craziest, you know outstanding AR you've ever seen working with a practice? Okay, fair enough. No, no, I'm talking about just a solo practitioner solo practice like what? Yikes. Yeah, but I have friends in bigger companies that see that are handling huge groups and DSOs and things. That's that's that's small potatoes. Right, right. But I mean, just imagine. Okay, so, you know, we've talked about verification. We've talked about demographic info. What other claim filing best practices do you often, you know, recommend that practices implement when you first start working with them? Yeah, sure. Well, one thing again is making sure that the attachments and the notes are included the first time around with the claims, submit the claims, clean the first time. And some of this is the burden on the doctor because if they don't get their notes done, then the claims are hung up. And that's how they fall through the sand, little sand falls through the cracks and they end up, you know, two weeks down the line and people forget to come back around and check them if they're not running their reports. I would run frequent reports to make sure all the claims are filed. And I would also encourage the doctors to get really good at finalizing their notes. They can be submitted and teams, you know, take really good images. Like right now, most of the insurance companies, especially some of the big guys are really requiring PAs with your crowns. They want to be to see the apex. If you're not taking good images, you're going to get a lot of denials. And if you're not preauthorizing it, you won't know until the patient's left the office and out the door they go. then you've got a collection Yep, yeah, absolutely. No, no, to that point, you know, the collection problem, that's a that's an after the fact problem. You are a big time advocate and champion of prepayment. So let's talk about that. What is that? What does that kind of look like? And I can imagine, you know, you encounter a little bit of pushback from some practices when you broach that subject. So what does that kind of look like to It's pushed back at the beginning because they're not used to it. They're used to I'll wait and see what the insurance pays and then we'll call you and That really is a problem Once they implement some of our systems doctors the most common thing I get is wow I didn't know I could do this and this has been a game changer. So I mean really best practice for you there regarding prepayment? How would you advise that a practice approach that? First of all, clear agreement on everybody on the team needs to be saying the same thing to the patient about their responsibility to pay their portion. And patients really need to understand that the relationship between the insurance company and the practice is minimal. The patient is the ultimate person responsible for their bill. And we may have a discount contractual relationship if you're in a PPO, but honestly, that's like a marketing thing. you know in exchange for getting listed on their website you're going to give a discount to your patients. Okay it's a bad marketing contract by the way it's more expensive than Google. Yeah, well we could get into that on a whole nother episode for sure. Right. But if you have clear upfront and honest conversations with your parents, with your patients, you have clear policies in place and everyone on your team adheres to the policy, you won't have a problem. And some of those policies can be simply explaining to the patient how long before the if you're out of network, how long before you'll charge your bill to them or maybe you collect in front and don't accept the assignment. And there's all different kinds of ways to look at that. My favorite way is to make sure you have a credit card on file. Mm now or debit card, but I prefer a credit card, of course. But if you can get a credit card on file, you can eliminate a lot of the downstream problems because you can do your best job as you went on on verifications and the insurance company is still able to find a way not to pay that claim when it back and they've increased the patient responsibility. If you have a credit card on file that's preauthorized for that date of service and those procedures, you can charge the balance without having to send a bill. Yeah, and so what's the best way to capture that credit card data? At what point in the process do you recommend practices do I recommend that you capture it at the time. Well, first of all, your financial policy needs to clearly state that that's what's expected, but I'd like to do it every time the patient comes in the office. I'd like to get reauthorized for the procedures that they're having done that day. And that way when the EOB comes back for that day, you know you have authorization for those procedures. Some offices get like a blanket thing in January, maybe when the patient first renews their policy or when they first come in. but they may not get restorative work until October. They forgot what they said in January. And I don't like the spring surprises on the patients. So I like to make sure that every time they come in, they're reaffirming their acknowledgement that this is their responsibility, that the EOB balances will be charged to the credit card on file. Yeah, absolutely. Now, you know, all of this is so good in theory, but in practice it can be tough. You know, we're not going to sugarcoat it. Of course, you and your company make it a hell of a lot easier. That's for sure. But you know, there's still, there's still some, you know, hard work that needs to be done on the practices end of things. And you and I were talking offline prior to recording this that, you know, staffing right now is so So hard for practices out there. I feel like I talk about it on every episode staffing somehow comes up inevitably And it's expensive, you know finding the right talent and keeping the right talent in a practice is very difficult and and costly and so who ultimately is responsible for implementing all of these systems that you've laid out here today and how affordable and feasible is that for most practices? And let's just stay focused on your smaller, maybe solo practitioners or smaller practices in Sure. In the best case scenario, you have an insurance team because it really is a team effort. Verifications are super time consuming and you need to have someone dedicated to that who's not going to be interrupted by having to answer the phone or check patients out. Same thing with pursuing your outstanding claims and just making sure that all the claims are filed cleanly. And that would ideally, in the best scenario, be the same person handling both those. In the best case scenario, depending on the size of the practice, once you get to two practitioners, I say one team member minimum per practitioner, because if you're going to do 30 claims a day, that's going to take all of your time. But an insurance coordinator can wrap that whole situation up really well. If you can afford to have a dedicated insurance coordinator, a lot of practices can't. And then it falls on the office manager. And the office manager could be wearing 16 different hats and really not have time to devote to the front desk person sometimes is not the office manager, the one who's answering the phone, scheduling patients, checking people out and handling all of the crises that arise. Sometimes it's put on them and they also don't have time for it. So personally, outsourcing has been the best scenario for most of the practices I work for. And so now your company then will handle that for them. Is that correct? We do. absolutely do. We have two ways that we work the practices. If you happen to have a rock star team and you just want them to get trained, we can do in-house training. But honestly, I don't see that yielding the results most of the time because as soon as you switch a team member, you're starting from scratch again. So I prefer the outsourcing and I think that's becoming ubiquitous across most of healthcare. about 60 % even of hospitals outsource a large percentage of their revenue cycle just because it's more cost effective and it's more efficient. Yeah. Yeah. Interesting. So, you know, how does it work? what are some of I would say, like, what are some of the symptoms? I guess, you know, we're talking healthcare, what are sort of the symptoms that a practice might have that indicates a need for maybe improve revenue cycle management? What are sort of the indicators, the yellow and red flags that you look at that say, might be time to to reevaluate Sure, well first of all, of course, the lack of a trained and competent team member to handle it, because it takes a trained and competent team member. Second would be if you notice that your numbers aren't looking like they should, if your production and collections are off. Yeah, my wife is mad or my husband's mad. Yeah, I'm not sending the kids to sports camp this year, whatever. They're definitely in because it's going to affect your lifestyle. If you have associates and they're not collecting what they need to like their own commission, they're going to let you know, hey, you yeah, that's that's a red flag because you don't want to lose associates. So there are there are a couple of stages. But to be honest with you, it should be the first thing on a dentist's mind is am I running a business or a charity? So those numbers need to be looked at from from the day you open your doors. And if you're not, if you're already behind, if you haven't looked at your practice as a business, that's the red flag that you need to address this. that's it. Your bottom line is determining whether or not you're going to be a success or a failure. Absolutely. Well, we've talked about a lot of really compelling strategies and tactics that practices can implement to make all of this happen and get back on top of things. But what does it look like, practically speaking, to work with a company like yours? you know, someone is listening today and is saying, well, it might be time to really pop the hood on those reports and see what we can figure out here. You know, I want to give you an opportunity at the end to talk about how to get in touch with you specifically and how to make the connection. But what is what does the arrangement typically like when you work with a new onboard a new Sure, well, we start off with just a conversation to find out, you know, where are the bottlenecks in their practice? And if the bottlenecks are at all around that revenue cycle, we can come in and either take it over, like I said, or craft a customized solution that works for the office. Some just want the verifications done, some just want the claims done, some want the whole shebang. We also do patient billing, and there's a suite of products that we offer, but it starts with a conversation. Let's talk to the doctor and find out what those pain points Sometimes the office manager is included in those conversations at the doctor's discretion. Next is the onboarding. And in onboarding, we're going to look at what software you're using, what the capabilities of our software, and also your clearing houses, et cetera. I've picked up practices that are still doing paper claims, believe it or not. Okay, that's not yours, Hopefully not. It's a thing. so helping them to modernize their systems might have to be the first step. But if they have all of the systems in place and they're still having a problem, then we're going to look at how are the customizations being done for that practice? What are the custom codes we can do? What are the protocols? Do prefer two days in advance or three days in advance? Are you going to be collecting from the patients? Are we going to be sending them like text reminders for payments, for instance, when the EOB comes in? Or do you want us just to charge the EOB? There's all different kinds nuances and customizations. Once we get that happening, then we want you to take your hands off and sit back and kind of watch the magic happen. yeah, that's where it gets really fun. So thank you so much, Monica. I can't tell you how much I appreciate you sharing your insights and your expertise within this area. If folks do want to have a consultation with you, what's the best way to find out more about RevSystems? How can they get in touch with best ways to go to RevSystems .com. That's our website. That's the easiest. And there's always contact sheets on there. I do respond as quickly as I possibly can. It is me responding. I don't have a whole ton of people responding. As I said, I'm a small company relatively, but I'm passionate about what I do. I'm passionate about communicating with the doctors, keeping in touch, monthly reports and things. My team members are equally passionate. And we really, I like to think of us as an extension of your team. about a 30 % discount because you don't have to pay employee taxes and benefits. yeah. great. Thank you so much. And I'll put all that information, your website, your contact info in the show notes. So folks, if you're listening and you're interested in connecting with Monica, check that out there at dentalscapes .com slash podcast. And in any case, Monica, thank you so much for dropping by. I do hope that we can have another conversation in the future. I'd love to bring it back if you're at all interested. And I will nerd out on this topic as often as you want. Just invite me back. you're just down the road from me actually we just found out you're in Hillsborough I'm in Chapel Hill. So we'll have to do this. Maybe we can record the next one in person sometime All right. All right. Well sounds good. Well, thank you so much Monica If you're just joining us for the first time on dental domination podcast Thank you so much for listening in if you enjoyed what you heard today I would please please please ask you go to Apple podcasts or Spotify or wherever you get your shows Leave us a five star review and a comment if you're willing. It's the best way to help us find new practices to reach and help and I can't thank you enough. So thank you all for listening in. Thank you so much for stopping by today, Monica, and we'll be in touch. Take care. All right, we'll see you.