One of the dental industry’s biggest challenges is finding and retaining talented individuals for all positions.? According to the American Dental Association Health Policy Institute, more than a third of dentists said they are actively recruiting hygienists and/or dental assistants.

Many dental practices and dental service organizations (DSOs) struggle with staff shortages in other positions. By the year 2032, it is estimated that the United States could be down by more than 36,000 dental workers, which could heavily impact staff productivity and the patient experience. So why the uptick in dental staffing shortages?   

Dental Staffing Shortages: Feeling the Burn  

The Mayo Clinic defines job burnout as a type of work-related stress that leads people to feel worn out physically or emotionally. In 2023, one out of ten dentists in the United States admitted to struggling with burnout on the job. Individuals with this level of exhaustion may experience:? 

• Self-doubt in their skills or abilities? 
• Lack of energy? 
• Difficulty focusing? 
• Trouble sleeping? 
• Less patience with colleagues and patients? 

When people feel like they are not important, it creates a poor culture, more burnout, increased turnover, and lower production.?“Many employees feel undervalued, overworked, and underpaid,” said Ian Prendergast, co-founder and CEO of Toothio, a dental staffing agency that specializes in finding qualified dental professionals.

Creative Solutions to the Dental Staffing Challenges? 

During the pandemic, people quickly figured out how to work remotely, but this often did not apply to the dental industry. In fact, 7,500 hygienists left the dentistry practice during this time. Dentists are now saying that recruiting hygienists is even more challenging now than pre-pandemic, according to the Journal of Dental Hygiene.  

And this applies to other dental positions as well. “We’re seeing a disturbing trend where in the next five years,” said Prendergast. “We need to get more efficient in how we operate our practices and get creative about how we’re recruiting the staff to support the practices.”? This means finding thoughtful dental staffing solutions to support and maintain a full staff, including:  

• Job sharing? 
• Hiring temp and part-time hygienists and dental assistants? 
• Implementing technology to reduce manual tasks? 
• Outsourcing remote work opportunities  
• Creating their own dental assisting schools? 

“Were in the middle of an evolution in the labor force right now,” said Prendergast. “It’s happening across multiple verticals, not just dental. People are prioritizing a new way to work, a new work-life balance. They want to be able to make money, they want to be able to take vacations with their families, they want to be able to watch their kids, and still engage in the industry that they love.”???? 

Leveraging Dental Technology and Tools? 

A great way to help reduce employee burnout and shortages is by utilizing dental technology and tools that already exist in your dental practice. Using cloud-based systems also enables teams in multiple locations to access patient files and information. This provides the flexibility that helps dental groups overcome staffing challenges.  

“Start by doing a workplace assessment to see how teams are using the systems today,” said Jill Nesbitt, founder and CEO of Optimize Dental Consulting, a company that optimizes technology for dental group practices.  

“They may not even realize there are built-in tools that will save them time and make them more efficient,” said Nesbitt. “Denticon, in particular, has a really strong functionality that can help streamline online scheduling, collections, insurance claim processing, and posting payments.” 

Developing Efficient Dental Processes 

With effective dental technology in place, dental groups and practices should next identify opportunities to improve efficiencies and processes: 

• Discuss with the team what will have the greatest impact.? 
• Determine the key metrics you will measure to evaluate success.? 
• Update documents and standard operating procedures (SOPs). 
• Establish a deadline for full adoption of the updated SOPs.? 
• Conduct ongoing team training.?
• Track key metrics and report on success.? 

?Another way to leverage technology is to train new team members.? Some dental groups have even created their own dental assisting schools to attract new people and will pay them during the training process. 

Enhancing the Dental Patient Experience? 

Having modern technology can help attract high-quality talent and streamline tasks to save time and energy. But why else should you invest in innovative technology? Your?dental patients expect you to have it—and your team will love you for it.  

From online scheduling to electronic appointment reminders to automated text-to-pay messages, your patients prioritize convenience and time-saving tools that let them manage their healthcare appointments and bills efficiently.? 

In addition, online scheduling has proven particularly useful, with target millennials and zoomers preferring online booking (73%) to phone calls, a significant way that saves valuable time for everyone.  

“We want to make your job easier,” said Nesbitt. “We want you to enjoy what you are doing and feel like how you spend your time is meaningful and efficient. We have invested in tools and technology that can do a lot of the work we used to do manually and want to make sure we’re using it to free up your time to focus on patients as much as possible.”? 

Dental Staffing the Right Way 

“When we have great team members aligned with the vision, who live our core values, who have clear expectations and see a path for growth within our organization, they are going to be happier, they are going to be more productive, and they are going to refer their friends to come work for you,”?said Josalyn Sewell, founder of joyFULL People, a registered dental hygienist (RDH) culture and confidence coach.  

Sewell specializes in setting up systems that create cohesive teams and well-run workplaces, where people want to join and want to stay.? She speaks about the core values that are essential guiding principles to hiring the right person:

• Heart: Excited to have the position? 
• Head: Right knowledge base?
• Hands: Right skills for the job? 

For example, if the core value is being growth-oriented, you may want to ask a potential candidate: “Tell me about a time when you took on a responsibility that helped you grow professionally.” ?It’s also important to use the first ninety days to confirm the person is the right fit for your company.? 

Retaining Your Dental Team 

In a competitive job market, how do you keep your talented team members? A successful method is to replace your traditional annual reviews with a shorter feedback cycle. This process may include:  

• Interview  
• Onboard 
• Train 
• Engage  
• Monthly feedback  
• Quarterly reviews?? 

Several dental practices and groups have started “stay” interviews in addition to exit interviews, a method of checking in and keeping your dental team happy, the perfect way to unlock their potential and energy—and keep them there for the long haul. 

For more tips, read the full Overcoming Staffing Shortages e-book or check out our on-demand webinar about implementing the right processes, technologies, and solutions to alleviate these shortages. 

This article was written by the Planet DDS staff and originally published on DrBicuspid.com.

At this year’s DentalForum, leaders from more than two dozen dental service organizations (DSOs) and purchasing groups gathered for what can best be described as “vendor speed dating.” 

They asked to be set up for one-on-one meetings with the top vendors of their choice in a rapid-fire series of fifteen-minute interviews.  

It’s an unusual event where the DSO leaders come because they want to mingle with vendors, and for two days in Austin, Texas, in late April, they built relationships over food and conversation.  

They also got a sneak peek at the Group Dentistry Now 2024 procurement survey, which many used as a benchmark on how their own organizations are performing. 

Syed Shoaib, Vice President of Facilities and Procurement at Eastern Dental

“I was a dentist in India, and when I came to the United States. I worked as a clinical assistant and as an office manager in a dental practice while I got my master’s in Health and Informatics. I also worked in the dental insurance industry and with a dental lab, so I have a well-rounded view of dentistry from multiple perspectives. 

“The biggest challenges we’re facing are the economy and inflation, and the higher costs of recruitment and retention. Those costs directly impact my procurement processes. When there’s turnover, it necessitates training and retraining, and you’re constantly trying to standardize your processes for ordering supplies and inventory management.  

“I was happy to see in the procurement survey that we’re on target with other DSOs. We’ve been running a tight ship and we’re spending about 4% to 6% of our revenue on supplies. We saw that more people are adopting AI [artificial intelligence] and technology to optimize processes including procurement, inventory management, facility access, revenue cycle management (RCM), and clinical decision-making.  

“This was my third DentalForum event and the networking is remarkable. From a procurement perspective, none of the other meetings are as productive as this one. We’ve piloted and implemented several solutions that we discovered through the one-to-one meetings in the past.”  

Jeanne Cook, 30+ Years of Experience in Dental Operations and Procurement

“I’ve attended DentalForum for the past five or six years and this meeting is of particular interest to me because of the dedicated time I can spend with vendors. This year, I met several new companies and plan to engage with them more, including: 

• Planet DDS to learn more about Denticon practice management 
• Bioclear Matrix Systems to learn more about minimally invasive composite restorations 
• KAD Dental Staffing to learn more about temp and temp-to-permanent staffing, which is in high demand 
• Several outsourcing companies such as Dental Claims Support to assist our operations so we can focus more on patients and spend less time with busy work like chasing down claims 

“We’re noticing people are joining group purchasing organizations to help doctors save money and combat rising costs. We’re always looking for ways to keep costs down while helping doctors maximize their time and productivity so they can help more patients. 

“Right now, I’m most interested in AI companies. When I was a dental assistant back in the 90s, I worked side by side with a doctor and this would have been a powerful motivator for patients, increasing their awareness of their dental needs.”

Bryan Womack, Vice President of Procurement at Dentive

“In the old days, you had one distributor, one formulary, and it was all about the relationships you had with one. First COVID supply chain issues, then cyberattacks on distributors and Change Healthcare showed us that you need to have a couple of options in place. You need to have a backup. 

“Relationships are still the key. Those preferred vendors are the ones that can save you when a piece of equipment is down and you need to get up and running right away. But you need to be risk-adverse in today’s environment. We’re having open dialogue and full transparency with our vendors to explain what our key initiatives are to work in partnership with them. Pricing is important, but it’s about more than price.? Your preferred vendors should be a partner with you to achieve your organization’s goals.  

“At DentalForum, I saw several services that intrigued me. Staffing remains a problem for DSOs and you can lose a lot of revenue with staff turnover, so services like Support DDS and other outsourcing agencies are interesting to me.  

“AI is definitely a trend that’s going to continue. A picture’s worth a thousand words, and patients respond when they can see the X-rays with AI analysis. Seeing images with highlighted color instead of grayscale is eye-opening for a patient.? Intraoral cameras were a huge hit, and I think like those, AI is a value-add tool that is here to stay. 

“Another trend is same-day dentistry. It’s not about cost savings so much as patient experience convenience. When you add up the raw materials, the cost of the equipment, the service fees and the salary of the person doing on-site milling or 3D printing, it’s pretty close to traditional lab costs for a DSO. The differentiator is being able to deliver same-day service to the patients so they don’t need to come back for a second visit.” 

2024 Group Dentistry Now Procurement Survey Results 

This April’s Group Dentistry Now procurement survey encompassed responses from 53 dental groups representing more than 8,400 practices. While about 60% of respondents said their dental supply spend is between 4% to 6% of revenue, about 20% of respondents put the figure in the 7% to 9% range. 

“It’s obvious from the survey that there’s room to optimize supply spend through consolidation and cost reductions throughout the rest of 2024,” said Karla-Marie Santiago, a procurement expert who worked for a DSO with forty-four locations before joining the Cavaretta Consulting Group.  

“DSOs continue to implement e-procurement platforms to not only increase efficiency in their ordering process but also track compliance with clinical formularies and monthly budgets,” said Santiago. “The use of data analytics in procurement will play a big role in making strategic decisions so doctors can deliver high-quality patient care while maximizing margins.”  

“Decreasing supply spend by just 1% can increase EBITDA [earnings before interest, taxes, depreciation, and amortization] by 4% to 6%. It’s all part of increasing value through strategic procurement approaches,” explained Amy Bridger, who is also with Cavaretta Consulting Group. She’ll be presenting a case study to walk dentists and operations specialists through the process during this July’s Dykema DSO Industry Group conference in Denver, Colorado.  

Fiscal management combined with delivering high-quality clinical care and an excellent patient experience all work together to help practices increase same-store growth. And that’s a trend that everyone wants to see.  

This is the second in a three-part series about the mergers and acquisitions landscape in dentistry. The article was written by Planet DDS staff and originally published on DrBicuspid.com.

Consolidation is the buzzword in the dental industry, and it’s not just dentists who are planning for retirement. The fastest-growing segment right now is small group practices – three to five locations – that are being acquired by larger dental support organizations (DSOs). There’s also movement with large groups; several DSOs with more than 70 practices are exploring mergers with even larger groups. 

“Groups that had variable rates on their debt have been squeezed recently leaving them in a bad position with their banks,” said Chris McClure, co-founder of Aligned Dental Partners, which provides M&A advisory and consulting services to group practices and DSOs. “Many have failed their bank covenants and don’t have leverage to fund new acquisitions.” 

Private practice owners and DSO executives are evaluating the market to determine the best time to sell. Many strategic buyers postponed transactions in early 2024 due to high interest rates and the rising cost of capital.  

“Same-store EBITDA growth is really important right now,” said Kevin Cumbus, founder of TUSK Practice Sales. “Buyers want to know: Is your business getting more or less profitable in today’s market?” 

What Dentists and DSO Executives Should Do to Prepare for a Sale 

Planning for a dental practice or group sale starts months, even years, before going to market.  

“I recommend practices get evaluated at least annually so you can identify areas to improve and position yourself for the greatest success,” said Rondi Michaux, the former Director of Corporate Development for two large DSOs.  

“Anything that makes you more efficient, lets you do more with less, and increases your A/R will help make you more attractive to a buyer,” said Michaux. 

As you’re evaluating your practice from a buyer’s point of view, consider: 

• Auditing all vendors to see if there are any that overlap and can be consolidated. 
• Analyzing how easy it is for patients to book appointments, receive treatment, and pay you 
• Moving to a cloud-based practice management system to eliminate the need for servers and streamline workflows, training, and reporting 
• Deploying technology that will increase case acceptance, such as artificial intelligence for X-ray analysis 
• Negotiating and optimizing fee schedules with insurance carriers 
• Knowing your numbers, including fixed costs, variable costs, and EBITDA (earnings before interest, taxes, depreciation, and amortization) 

Advanced practice management systems such as Denticon now include online scheduling and digital forms, email and text message functionality, revenue cycle management automation, detailed reporting and analytics, and other tools that are used to require third parties. Evaluating your tech stack regularly will ensure you’re not paying for duplicate services and improve your EBITDA.  

From Coffee to Close: What Happens within 90 Days  

The seller sets the pace of the sale. From “coffee to close,” a sale typically takes 60 to 90 days, although it can take longer, said Rondi Michaux. 

Once both parties sign a non-disclosure agreement (NDA), the buyer will typically request: 

• Up to three years of P&L statements (Profit & Loss), balance sheets, new patient numbers, practice production, and collection reports broken down by provider 
• Real estate contracts and equipment expenses 
• Associate contracts and staff W2s 
• Any fees charged to the company, such as country club memberships or entertainment expenses 
• Disclosures of malpractice claims, legal situations, and inter-office relationships 

A traditional sale timeline may include: 

• Gathering financials, operational details, employee matters, contracts, legal, and regulatory information. Consider having your practice manager sign an NDA and possibly include a bonus for the manager’s time, effort, and discretion.  
• Having a lawyer review the NDA  
• Conducting due diligence  
• Understanding add-backs for any expenses or information not originally disclosed 
• Determining the financial details and deal structure  
• Reviewing the Letter of Intent (LOI) with a lawyer 
• Conducting more due diligence  
• Renegotiating the real estate lease/contract 
• Potentially meeting the dentist’s spouse and associates before the sale  
• Meeting the dental team, which may happen either right before the transaction or after the sale is final 

Dental Brokers, Attorneys, and Letters of Intent 

Many dentists and dental group executives prefer to hire an M&A advisory firm to help guide them through the process. 

“Our job is to protect our clients from tire-kickers,” said Kevin Cumbus at TUSK Practice Sales. “We can do all the financial and operational diligence on a trailing 12-month basis (TTM) in a few weeks, pull together a full analysis of the business and the adjusted EBITDA, and vet potential buyers – all while keeping your identity a secret.” 

In this scenario, potential buyers sign a non-disclosure agreement before meeting with TUSK to walk-through the seller’s story and data.  

TUSK explained its process and how different deals can be structured in a DrBicuspid.com article on April 11, 2024. 

Top Tips for Telling the Dental Team That You’re Selling 

Experts recommend having the buyer and the seller together tell the team about the sale. Oftentimes, it helps to have someone from the buyer’s human resources team on-site to answer questions. 

“They’re going to want to know how this affects them,” said Rondi Michaux. “They want to know how this will impact their job, their salary, their benefits, their vacation time.” 

There are often operational questions, too, such as whether the name of the practice is changing, how long the original owner will work post-sale, and what they should tell patients.  

The key to success?  

“The team will follow the doctor’s lead,” said Michaux. “If you’re happy and excited, if the messaging is clear and concise, if you have answers to their questions, and if you explain why you couldn’t share the news with them earlier, then the team will respond positively.” 

In many cases, team members are not surprised. Currently, about 35% of the dental industry is consolidated. That number is projected to jump to 75% or 80% within 15 years. That’s why many dentists and DSO leaders are starting to prepare now, so they can make the best decision for their company in the future.  

In Part 3 of this 3-part series on dental mergers and acquisitions, experts share the red flags that buyers look for when evaluating a merger or acquisition. If you missed Part 1: Top Tips for Dental Practice Owners, please click here.

This is the first in a three-part series about the mergers and acquisitions landscape in dentistry. The article was written by Planet DDS staff and originally published on DrBicuspid.com.

For many dentists, it’s a scary statistic: 75% – 80% of dental practices will be affiliated with a dental support group within 10 years. 

That’s the prediction from Brian Colao, the Director of the Dykema DSO Industry Group, and the nation’s foremost expert on mergers and acquisitions in the dental space. 

The consolidation trend started in 2010 and quickly accelerated in 2015 when it was easy to get financing and investors were willing to pay 10X, 12X, and even higher multiples in their evaluations. That trend continued until about 2021 when higher interest rates started impacting the market, Colao says.  

Even so, about 30% of the dental practice market is currently affiliated with a DSO. 

M&A 101: Truth vs Fiction 

One of the biggest fears of private practice owners is the concern they will have to give their clinical autonomy. That’s not what happens, said Duff Bourassa, a Managing Director in the healthcare division of E78 Partners, an accounting advisory firm.  

Another myth is that the DSO wants the dentist to leave.  

“Most DSOs want you to work for at least two years,” said Bourassa. “The more time you commit to staying, the more likely you’ll get a better offer from a potential buyer.” 

The number of deals closed in the first quarter of 2024 was lower than expected, mostly because of higher interest rates. 

“DSOs are being more discerning than ever with their acquisition strategy,” said Chris McClure, co-founder of Aligned Dental Partners, which provides M&A advisory and consulting services to group practices and DSOs. “They’re seeking to affiliate with practices that have greater than 20% EBITDA, are willing to roll equity, and where the owner dentist will stay on for five to seven years.” 

Top Tips for Practice Owners Thinking about Selling to a DSO 

Knowing how long you want to continue working will influence your transaction.  

“If you’re trying to get out within two years, then you may want to get a 100% buyout,” explained Bourassa. “But if you’re willing to work longer, then you want a deal that has more equity.” 

Rondi Michaux is the former Director of Corporate Development for two large DSOs, 42 North Dental, which is based in Boston, and Dental Care Alliance, which is based in Sarasota, FL. She also has years of experience in operations.  

She recommends asking these questions if you’re considering selling your practice or group to a DSO: 

• What are the terms of the employment contract?
• How is the deal structured? Will it be a joint venture? Will you receive equity in the parent company? 
• How long are you expected to work after the transaction?
• How will you be compensated?
• What is the DSO’s management fee?
• How many hours are you expected to work and how will vacation / time off be handled?
• How are lab expenses factored?
• How will your lease or real estate investment be handled?
• Will the name of the practice change? 
• Will you be compensated if there is a second equity event?
• What will happen with your associates and team?
• If you have associates, what happens to the existing doctor contracts?
• What happens with employee benefits? Vacation time? Sick leave?
• When and how will the DSO team want to meet with the practice team?
• What needs to be planned for the transition, including payroll processing, technology changes, and culture expectations?
• What will happen with your patients?
• How will they be told, especially if you are retiring / leaving the practice?

Deciding When Is the Right Time for Dentists to Start Talking to Potential Buyers 

If you’re planning to sell your practice or group to a dental support organization, you need to have a plan. 

Brian Colao recommends practice owners take these three steps: 

1. Leverage all of the technologies available to you. These include adding artificial intelligence to aid in diagnostics, automation that can streamline and shorten the revenue cycle, procurement solutions that will cut costs and maximize the discounts available to you, and practice management systems that can increase efficiency and run reports that help you track EBITDA and key performance indicators in real time. 
2. Evaluate your overhead to ensure it’s as low as possible. Colao recommends reviewing and optimizing your payor mix and adding the appropriate infrastructure that will help you prepare for a future equity event. 
3. Review your accounting practices and ensure you have properly prepared financials. Potential buyers are going to want to see them. 

Once you have decided that you want to start the process, consider hiring an expert to guide you.  

“You only get one chance to sell your life’s work,” said Kevin Cumbus, Founding Partners and President of TUSK Practice Sales. TUSK excels at working with owner-founded and debt-funded practices to prepare them for sale. It will then identify potential buyers that are a good match, handle the non-disclosure agreements, share the appropriate information to help drive up interest and enterprise value, and go through the sales opportunities with you. 

Whether you choose to prepare your files yourself or hire a professional broker, you will need to provide financial and operational due diligence dating back at least a year.  

From “coffee to close,” the sale process can take anywhere from 60 to 90 days, said Rondi Michaux, although some deals take up to six months. 

In Part 2 of this 3-part series, experts share the timeline that sellers should expect, including when to let your team know about the transition.  

This article was written by Planet DDS staff and originally published on Orthodontic Products.

SOC 2 Type 2 certification is one of the ways that software companies like Planet DDS show that they take cybersecurity seriously.

In our increasingly technological world, healthcare providers have replaced banks and convenience stores as the targets of small-time crooks looking for a big score. But it isn’t the cash register or vault they’re after, but valuable patient data that has focused the attention of a global crime wave of virtual smash-and-grabs looking to steal and hold that data for ransom.

While the internet and cloud-based software have streamlined the old days of paper files and metal filing cabinets, the digital era brings a host of vulnerabilities and new concerns for small healthcare businesses like private orthodontic practices.

That’s why software companies that serve orthodontic practices, like Planet DDS, have gone out of their way to shore up their clients’ cyber defenses. The company recently announced that it had achieved System and Organization Controls (SOC) 2 Type II certification, a data security standard for enterprise software. But while SOC 2 Type II certainly sounds official, what exactly does data security certification entail?

SOC 2 Type 2 at a Glance

• System and Organization Controls (SOC) 2 Type II is a set of trust services criteria for data security, privacy, confidentiality, integrity, and availability developed by the American Institute of Certified Public Accountants (AICPA), one of the largest auditing bodies in the United States.
• SOC 2 Type II is the vehicle through which software companies like Planet DDS can receive third-party validation certifying that they have put proper security and privacy controls in place. It requires an investment of time and money from the company seeking certification and includes an ongoing auditing process that takes place over several months.
• It is one of several third-party security frameworks that enterprise software companies can choose to show compliance with the Health Insurance Portability and Accountability Act’s (HIPAA) broad standards for data security. Other cybersecurity frameworks include the National Institute of Standards and Technology (NIST), the Center for Internet Security (CIS), ISO 27001, and HITRUST.

How Do SOC 2 Type 2 and HIPAA Come Together?

The effort to meet SOC 2 Type II standards was headed by Liz Duncan, director of compliance and cybersecurity at Planet DDS. Duncan has spent more than 3-decades of her career combating cybercriminals. Working in Silicon Valley, she was there during the early days of cybersecurity threats, working on antivirus software, malware protection, and network data security. She later shifted her focus to smaller organizations that were often behind the ball in terms of cybersecurity compared to larger corporate America.

While HIPAA provides the basis for the regulation of cybersecurity standards around patient data, Duncan says that the actual language is broad and leaves it up to companies to prove that they are meeting the letter of the law. Like a set of divine commandments, it’s more of a list of “Thou Shalts” rather than a detailed breakdown of what it means to be compliant.

“HIPAA really isn’t prescriptive about what ‘thou shalt do,’ but it uses words like safeguards, reasonable under the circumstances, applying due diligence, and best practices,” says Duncan. “And that really leaves organizations with a hole in terms of what they need to do to demonstrate HIPAA compliance.”

Under HIPAA, companies are allowed to provide self-attestation that they are in compliance with regulations, but at the end of the day, they’re just taking the word of a company that they’re being compliant. As a result, several third-party cybersecurity frameworks like SOC 2 Type II have been developed to help companies demonstrate to the government and, more importantly, to their clients, that they are taking data security seriously.

SOC 2 Type II is a thorough audit covering best practices, like encrypting data when it is stored and in transit. It ensures that access controls are only providing the minimum amount of access needed to perform a job. It also investigates the organization from top to bottom to gauge leadership’s engagement with cybersecurity and data privacy risks.

“When you have to demonstrate your data security and privacy controls to a third-party auditable standard, it demonstrates a level of maturity of your control environment,” says Duncan. “More importantly, it demonstrates the commitment to the security and privacy practices, because it isn’t something that you can accomplish overnight. It’s actually a continuous operational effectiveness, where your controls are evaluated day in day out, week in week out, monthly, quarterly, annually.”

Cybercriminals Understand the Value of Your Data

As a healthcare provider, orthodontists are legally responsible to protect the sensitive data they use to provide thorough treatment for patients. In the healthcare industry, the personal healthcare information (PHI) that orthodontic and dental providers have access to is in a lower-risk category than a medical or mental health institution might have. However, it is still subject to the same legal protections.

Unfortunately, hackers are well aware of this fact and rather than spending all their time trying to take down the Change Healthcares of the world, they look for the easy prey—private practices.

“The healthcare industry in general, but particularly dental and ortho, has been flagged as easy pickings,” says Duncan. “It sounds a little bit rude, but the FBI actually uses that term, easy pickings.”

One of the primary reasons for healthcare’s unique vulnerability is that there are often many points of access to valuable data. Instead of having a single comprehensive solution for all their needs, healthcare organizations rely on multiple different software solutions so that each has access to the same data. Each device or software solution can become a potential weak point that hackers can exploit to break into a system and take what they need.

Offloading Your Cybersecurity Risks

Large businesses can and do spend billions on cybersecurity every year, but a single orthodontic practice cannot feasibly afford the dedicated protections that top healthcare institutions invest in. That’s why, Duncan says, it’s important for orthodontists to offload as much of that risk as possible to a company that can demonstrate its ability to protect sensitive data.

Cloud-based software has enabled that capability for private practice owners, allowing important data to be stored offsite in more secure locations where it can be backed up and ready to restore if a breach occurs. Unfortunately, the dental world has been slow to modernize.

The FBI considers dental and orthodontic practices to be at least 10 years behind where the rest of healthcare is in understanding the need to move things out of the office and into the cloud, says Duncan.

“The idea of the dental practice with a Windows 7 server in their closet that somebody reboots when something gets hung, and that’s all they ever do with it—that still exists,” says Duncan. “In this day and age, nobody should ever be running their own infrastructure. The risk is too great, and the overhead of trying to hire the staff to maintain it is pretty significant. So, we can all outsource that aspect of it by making sure that you’re looking for purely cloud-based solutions.”

The Cost of Ignoring Cybersecurity Risks

Duncan recalls a client who had a significant ransomware attack where someone high up in the organization clicked on a phishing link. The link installed a keylogger on their computer, collecting login information that was used to access the practice management system where the hacker started exporting data.

A data exfiltration event, as it’s known in the cybersecurity world, is often a nightmare scenario for a private practice. The hacker was able to access sensitive patient documents and images and encrypt the files so that the client no longer had access. However, the hacker installed no viruses to disable the software. The PMS was still up and running with no impact. Yet, without access to the critical data, the office was forced to shut down for 2 months before it could return to operational order.

When cyberattack events make the news, the focus is often placed on the astronomical ransoms that some organizations pay hackers to get back their data. However, the real cost, particularly for private orthodontic practices, is its damage to a doctor’s ability to treat patients.

Had that practice’s files been backed up and stored in a secure location, it might have been able to return to operation with minimal delay. Duncan always recommends that organizations plan for these worst-case scenarios. Running a disaster exercise is in the practice owner’s best interest, and, Duncan says, it can be fun for the staff as well.

“It’s an investment in time, but it’s definitely worth it. Thinking through every aspect of how you operate, documenting it, and then training people on it,” says Duncan. The middle of a major incident is not the time when you want to have to figure it out. You don’t have to be super sophisticated. Just talking through what you would do under these circumstances usually generates a lot of really good ideas for how you could continue to operate.”

Dental technology is evolving quickly to meet the expanding expectations of consumers, clinicians, and team members. 

Many of the new and maturing technologies were on display at this year’s Chicago Midwinter meeting. Here is what four thought leaders – ranging from a private practice owner to an executive with the country’s largest DSO – think are the must-haves for 2024. 

Some of the answers have been lightly edited for clarity and space.  

Louis Kaufman, DDS, owner of Smile Design Studio of Hyde Park, and a Smile Source administrator for the Chicago region. Smile Source is a community of more than 700 independent dentists.  

“For sure, it’s anything to do with AI. I’ve been a big user of Pearl for 18 months. That is a definite win for the practice and for the patients in terms of education because they’re seeing what you’re seeing. I highly recommend that. AI for periodontal charting and note-taking is also taking off.  

“Virtual receptionists are really big right now for online scheduling. I saw a few companies at Midwinter. I’m also looking at Toothapps, which normalizes data and integrates websites, calendars, instant messaging, teledentistry, and digital forms in a single place. 

“Cloud-based platforms are important because of the speed, accessibility, and storage. I’ve been using cone beam for 13 years; it eats up your storage. With scanners and digital dentistry, we have so much data. We’re capturing everything digitally, so going cloud-based is a must.  

“I think 3D printing has a lot of buzz and I can’t wait until it becomes more affordable. There are some great systems on the market, and many were exhibiting at Midwinter. Everyone talks about what they’re saving compared to sending out to a laboratory, but what is it costing you in terms of your dental assistant’s time and for the dentist who loses chair time. I also think robotics will be huge in a few years, such as the Yomi guided dental implant surgery robot. We all know that dentistry is back-breaking, so anything we can do ease the pain and suffering will be welcome.”  

Sundeep Rawal, DMD, Senior Vice President of Implant Dental Services at Aspen Dental, a DSO with more than 1,000 affiliated practices nationwide. 

“At Aspen, one of our primary focuses is the patient experience and making it easier for them to get the care they need in ways that are convenient and easy to access. One area where we are enhancing the experience, and which excites me, is the investments we’re making in artificial intelligence. Two good examples including have AI help facilitate scheduling and answering some of the basic questions patients have, such as where the office is located and the office hours. That’s becoming more automated, and we’re using artificial intelligence to help us make better decisions about what kind of availability we have so patients can get the appointment they need in the time frame they need it, on the day they need it, that fits their lifestyle.  

“Then you think about once they come into the office, how can we use AI. We’ve been looking at AI diagnostic analysis for over five years and the maturity in that technology is rapidly changing with the new FDA clearances. It’s allowed us to feel really confident to scale that technology, and it’s one of our strong initiatives for 2024. 

“We’re leveraging AI technology and automation on the backend to make it easier for patients to pay their bill, and integrating it into the revenue cycle. 

“Everything we do is geared toward giving patients a better experience. We have digital forms. We invested in digital design with CAD/CAM and 3D printing. We’ve done hundreds of thousands of digitally-printed dentures and it’s been amazing for patient care. Anything we can do to make it an easier experience, and deliver on our promise to patients to deliver faster and more predictable outcomes that are affordable, is a win across the board.” 

Trevor Maurer, CEO of OMS360, an oral surgeon support organization that operates 17 practices in five states, and an Operating Partner at Shore Capital, a private equity group which has started 58 companies including OMS360. 

“Turnover is difficult right now for non-clinical positions including the front desk team. Constantly training new hires is expensive and exhausting. We implemented Patient Prism which records our new patient phone calls and provides almost immediate training on how to provide better customer service, convert more appointments, and improve practice performance. ?It’s a valuable tool in our integration of new partner practices. If they are not seeing a high conversion rate, we will delay deploying marketing resources until the Patient Prism statistics prove the practice is ready for higher call volume and can service those patients who want to come in to see our doctors. 

“Another technology that’s working well is Remit AI from Zentist. It has saved us countless hours of labor in RCM (revenue cycle management). We only recently deployed that, but we’re already impressed. 

“What I’m really excited about in the future is the potential to use AI to actually book appointments. I’ll wait for now, but am keeping a close eye on that technology as it becomes more mainstream.” 

Melissa Malloy, Vice President of Operations of Heartland Dental, a DSO with more than 1,700 affiliated locations across 38 states and Washington, D.C. 

“Heartland Dental takes a thoughtful approach to implementing new technologies. Our support teams made up of industry leading experts are constantly learning from the external environment and exploring new technologies that can help our supported doctors enhance patient care in their communities. 

“Over the years, we have implemented various technologies to enhance our Business Assistant role and streamline processes such as insurance verifications. Late last year we rolled out AI technology across all our supported offices. This has enabled our supported doctors and dental office team members to delve deeper into AI’s potential and leverage it effectively in patient communications and elevating patient care while maintaining clinical autonomy.” 

Innovate to Elevate Patient Care 

It wasn’t that long ago that dental practices had answering machines, fax machines, and photocopiers.  

And patients used to receive paper statements, write out checks, put them in an envelope with a stamp, and mail them off. 

Times changes. How you run your business has to change, too. 

Gone are the days when you needed separate companies for each part of the patient journey. Cloud-based practice management systems like Denticon can manage each part, from online scheduling and form completion, to two-way texting and automated patient communication, to eligibility verification, claims processing, and ERA auto-posting, to automated payment reminders, which give patients an easy way to pay online. Sophisticated digital imaging services now have embedded AI functionality that helps detect lesions, open margins, and bone level measurements. 

With the advancement of APIs and technology integration, team members can save hours by automating tasks that used to be done manually, such as reporting and data analysis. These are technologies that will be must-haves as dental practices and dental support organizations strive to attract tech-savvy dentists, team members, and patients this year and in the years to come.

This article was written by Planet DDS staff and originally published on Dental Product Report. Group dentistry experts share strategies and predictions at the Yankee Dental Multi-Site Summit.

Mergers, acquisitions, and the consolidation of dental practices were the hot topics at the 2023 Yankee Dental Multi-Site Summit in Boston, with the biggest jaw-dropping prediction coming from Brian Colao, the Director of the DSO Industry Group for Dykema.

He predicts consolidation in dentistry will jump from 31% now to at least 75% within 15 years.

“There’s a great evolution in consolidation going on, from private dentists to small groups to DSOs, and it’s been accelerating since 2015,” Colao explains.

One of the reasons? The economy.

“The economic landscape of 2022 and 2023 presented significant challenges for many groups, largely attributable to macroeconomic variables,” says Steve Saukaitis, CEO of Select Dental Management, a group that has partnered with 37 practices across the Northeast and Mid-Atlantic regions.

“Organizations that dedicated their efforts to sustainable same-store growth and the enhancement of both patient and employee experiences have strategically positioned themselves for success,” Saukaitis continues. “These focal points are instrumental in fostering a resilient organization and driving performance in today’s competitive environment.”

Operational Excellence Cited as a Must-Have for DSO Growth

“In today’s climate of rising personnel costs, shrinking margins, and costly capital, the era of growth without operational excellence is ending,” says Scott Leune, DDS, founder of Breakaway Seminars, a dental business consulting firm.

Throughout his career, Dr. Leune has opened, built, and sold numerous dental practices, and currently supports more than 20,000 dentists with purchasing, marketing, consulting, and additional services.

“Whether it be a new dentist in a single location, or an established DSO, it is vital that the owner understands how to create accountability within the team to follow best practices that maximize patient experience and healthy profits. The end result will be a practice that can easily afford today’s higher salaries while delivering a new modern level of patient care, and an owner that has excess time and financial gains without the heavy weight of staff and practice implosions,” Leune explains.

A key focus of these DSO leaders is modernizing the dental experience. This can include enhancements such as making it easier for patients to schedule and complete new patient forms online, adding artificial intelligence (AI) analysis of x-rays, implementing cloud-based dental practice management systems such as Denticon, and automating revenue cycle management through tools that streamline eligibility verification, claims processing, and auto-posting payments.

“With the economic situation we’re in now, it’s essential that we’re making it easier for people to do their jobs,” says Dee Fischer, CEO of Fischers Professional Group and a partner in two DSOs, each with three practices. “It used to be that you can hire quickly and fire quickly, but no more. Now, you have to retain people. You have to train them well. You have to create a culture where they want to stay. Companies are integrating artificial intelligence to automate what used to be very time-consuming tasks, and that’s making it easier for the dentists and team members to focus on patient care. Do that, and you’ll see the difference on your P&L [profit and loss statement].”

DSOs Investing in their Dentists and Staff

While the term DSO stands for dental support organization, it has become an umbrella term that is used for everything from small group practices owned by a single dentist, to large groups with hundreds of locations. Typically, what elevates a group of individual practices into a DSO is the consolidation of shared non-clinical services, such as human resources, marketing, credentialing, billing, IT, and real estate.

The culture and structure of each DSO can vary widely.

“A lot of dentists think that joining a DSO means they become an employee and lack the ability to invest in the business as a retirement strategy. This is sometimes the case, but more and more frequently is no longer such. Many groups are developing options such as equity incentives, equity ownership, joint ventures, profit sharing, and other models that allow for associate dentists to have ‘skin in the game.’ These structures could be individual practice-based, regionally based or even top level, company-wide. There is a variety of options out there for doctors wishing to enlist management support but still retain some form of long term financial investment and reward,” says Lorri Detrick, president and COO of Riccobene Associates Family Dentistry, a doctor-founded rapidly growing group with more than 70 locations in North Carolina, South Carolina, and Virginia.

“It’s obvious that we in DSO leadership need to create value not just for our patients, but also for our providers and our teams if we hope to be successful,” says Adam Richichi, CEO of Archway Dental Partners, which has 28 practices in Connecticut and is expanding to other states in 2024.

As more private dentists and small group owners consider partnering with a larger organization, it’s important for providers to ask how the DSO will help them better care for patients.

“Scaling within the 4 walls of your practice requires the ability of your leadership team to prioritize, measure, create individual accountability, and incentivize alignment around the most impactful opportunities to improve patient care and practice growth,” says Elliot Zibel, founder of Optimus Healthcare Management and previously co-founder and CEO of Select Dental Management.

Healthy DSOs have short-term and long-term goals for implementing technology, training, and tools that will help their affiliated practices succeed.

“Understand the levers available to you to scale your dental practice, create KPIs to measure your success as you work towards your goals and create a high-performance culture by aligning the values of your team with those of your practice to ensure an environment of accountability,” says John Geary, chief strategy officer at Independence Dental Services, a partnership organization with 49 practices across 14 states.

DSOs Leveraging Specialty Care and Hygiene Programs to Propel Growth

Several of the panels at the Yankee Dental Multi-Site Summit focused on clinical quality oversight, scaling up hygiene operations, and sharing the challenges and successes different groups have had.

“There has been a strong emphasis and focus on specialty dental practices over the last few years. It was very interesting to hear from two specialty-only DSO leaders that their specialists including oral surgeons and endodontists appreciate being part of a larger community of their own specialists. A couple of the larger DSOs mentioned they are partnering with specialists who prefer to be part of a bigger team of general dentists for referrals. A big question for the future is how can we achieve more integrated dental care for patients and which model will be more successful?” asks Rashed Din, CEO of Maya Dental and a partner at Din Ventures, a private equity firm that is also an investor in Archway Dental Partners.

Many groups have leadership positions including Chief Clinical Officer, Vice President of Specialty Dentistry, and C-Suite or Director-level representation of hygienists.

“Our panel discussed the structure of hygiene leadership within our respective DSOs and the importance of implementing and maintaining hygiene representation within DSO leadership,” says Erin Kierce, RDH, MS, MPH, chief compliance/hygiene officer at Passion Dental, a group of 54 practices in New England. “We reviewed the manner in which we measure success and our respective approaches to recruiting hygienists, as well as onboarding, training, mentoring, salary and benefit considerations, and retention. Underlining it all is how we approach measuring the standard of care through quality assurance procedures.”

The Big Take-Aways from the 2024 Yankee Dental Multi-Site Summit

“The discussions on ‘Same-Store Growth Through Innovation’, ‘Scaling Your Practice in 2024’, and ‘Best-in-Class Operations’ directly aligned with my focus on driving operational efficiency, growth, and scalability across our footprint,” says Karla-Marie Santiago, senior director of practice optimization and growth at Oakpoint, a group with 44 locations in the Southeast region of the US.

The networking was just as important as the sessions, Santiago said. “The intimate setting enhanced my ability to forge strategic partnerships with industry leaders and vendors, crucial for our continued expansion and operational excellence.”

Whether they choose to stay in private practice, join a group purchasing organization (GPO), or explore partnering with an established DSO, dentists have more information than ever before to make an informed decision.

By: Anjuli Avis, RDH, Guest Blog

 There is so much buzz around artificial intelligence in Dentistry right now. It’s easy to get caught up in something that is this innovative. So, is it worth the hype? As someone who has been using it for the last few years clinically both for my own patients and for implementation and training purposes, I can tell you it is absolutely worth the hype. But how does one get started using it?

Here’s my “starter kit” for implementing this technology in the op and in the front office. It’s the protocol that my hygienists and myself use. It just scratches the surface, but it’s a great way to start implementing these wonderful tools.

Remember, the protocols here can be utilized for most platforms designed for reading radiographs and information in your practice management software (PMS).

Easy, breezy chart prep with AI

I have my teams print their schedules through the AI dashboard. Here they make notes and use it for feedback during their morning huddles. These are the basic building blocks for comprehensive treatment planning.

Most platforms will provide:

• Last date of x-rays (BWX, FMX).
• Last date of probing.
• What patient is scheduled for today.
• Unscheduled treatment for both hygiene and doctor.
• AI recognition of possible missed treatment.
• Some software will now provide the date of the last health history.

Review X-rays, augmenting experience with AI

Reviewing x-rays includes analyzing the artificial intelligence measurements of:

• Bone loss – CEJ to the bone and compare with periodontal charting.
• Incipient decay – This indicates opportunities for Curodont Repair by vVARDIS for remineralization of enamel once decay is confirmed with the Doctor.
• Abnormalities of all tooth structures highlighted in color blocks or in boxes to review with the doctor.
• Narratives matter, so this is a time to check the quality of x-rays for submission to the insurance company.

Review of Treatment Plan

Clinicians use “scheduled for today” columns and compare with their diagnostics to:

• Confirm the accuracy of the treatment plan.
• Present opportunities to the doctor based on what the AI detects as not yet treated or treatment planned. The artificial intelligence analysis is basically the equivalent of: “Hey, look at me! Do I need attention?”

During the Dental Appointment

• Shortcuts, where available, should be used to get to x-rays quickly.
• Use computer monitors, smart TVs, or iPads for educational purposes.
• During periodontal charting, hygienists review the AI and make notes for the doctor.
• Doctors should review the AI findings also, which helps strengthen calibration and treatment planning.
• Automated periodontal charting and restorative charting is available on some platforms. Use this for quicker comprehensive and new patient exams.

Efficiency is crucial, especially as dentistry faces a labor shortage.

Operations

• Unscheduled treatment and recare reports are available in most of the AI platforms, which can help teams identify patients who need to return and help maintain a full schedule.
• My teams utilize these reports to fill their schedules during slow seasons and to partner with the front office team.
• These reports are easy-to-read and visually pleasing.
• Weekly review of these reports is recommended and can be discussed at team meetings or huddles, depending on the need.

Marketing and Business Assessments

Artificial intelligence can assist the marketing department assess your presence in the community. For example:

• DMscore will break down your visibility and ranking versus competitors, based on price per click, SEO, and mapping. Review this monthly at least.

Artificial intelligence programs can also help with employee training.

• Patient Prism uses an AI algorithm to re-engage lost patient opportunities. It measures team member interaction with patients on the phone and gives you tangible feedback to facilitate coaching.

Other Ideas

I encourage my hygienists to utilize QR codes for the websites of the products they are using so patients can see how cool it is! This can be done with any company you decide to partner with in your practice. Let your patients in on the conversation.

The Takeaway

Artificial intelligence is a transformative force in dentistry, offering a myriad of benefits for both patient care and practice management. By incorporating these protocols, you can harness the full potential of AI in your dental practice.

_ _ _

Anjuli Avis has been a dental hygienist for 18 years. She has been a clinical coordinator, hygiene mentor, trainer, study club content creator and presenter. Anjuli is an advocate for consistent and thorough diagnostics like salivary testing, oral cancer screenings and artificial intelligence.

She enjoys writing for industry newsletters that address modern challenges for dental clinicians. She has worked in teledentistry with a primary goal of creating increased access to integrative and preventative healthcare and in continuing education. Currently, she is a Regional Director of Hygiene for a DSO in the U.S. with the main goal of implementing best practices in the hygiene department.

There are many reasons why people hesitate to find a new dental practice. Often, the reason is that they don’t know who to go to or who to trust. But often, they just feel that it is a hassle. Calling the new dental office to schedule the first appointment can take too much time. Then, there are the endless forms, consent agreements, and insurance information to fill out. For the dental practice’s front office, onboarding a new patient can be equally time-consuming, distracting the front office from providing the best overall patient experience.  

Planet DDS saw these challenges, and we have now made improvements to the online registration process. With the new Denticon Patient Online Registration, both dental practices and patients can take advantage of five new features that will save both parties’ time. 

• Create a custom welcome message for online registration: Dental practices can now create a custom message as the first message a patient sees when they enter the Denticon Online Registration Portal. This allows dental practices to promote and maintain their brand with the first message new patients see. 
• Designate required fields in registration forms and questionnaires: For new patients, the forms they have to fill out can seem daunting. There are many questions and fields to complete. Denticon now allows dental practices to designate which fields are required for the patient to complete and which are optional. This eliminates back-to-back conversations about incomplete forms, saving both dental practices and new patients time while also improving the patient experience. 
• Quickly create new patient appointments: Denticon has made improvements to the user interface to schedule a new patient appointment. Denticon now minimizes the time on the phone when scheduling a new patient with an improved top-to-bottom logical user interface that only requires four fields to create an appointment: birthdate, last name, first name, and phone number. 
• Automatically send new patients an email with a link to required forms and consent agreements: After scheduling a new patient appointment, Denticon is now integrated with Denticon Patient Communication, an effective and efficient patient engagement solution that can automatically send a customized email or text message to a new patient with a secure link to any required forms or patient consents before the patient’s visit. This allows the dental practice to communicate with new patients in the way they prefer and saves the front office time. 
• Upload an image of a patient’s insurance card: The new online registration allows the new patient to upload an image of his or her insurance card to capture the patient’s insurance information accurately and ensure efficient payment processing. 

At Planet DDS, we are excited about these new enhancements that will maximize the patient experience right from the beginning. 

For any questions or more information, please reach out to our team. 

This article was written by Planet DDS staff and originally published on Group Dentistry Now.

Revenue Cycle Management (RCM) is all about getting paid for the services your dental practices provide.

Historically, it’s been labor intensive, and there’s room for human error at just about every stage.

Here is how sophisticated, cloud-based practice management systems are incorporating automation, workflow tools, reporting, and analytics to help DSOs improve their RCM processes and increase collections.

Automating RCM and Integrating Workflow Tools to Increase Efficiency

“Top RCM priorities of DSOs include automation, greater access to insurance information, and integrated workflow tools. These are key to solving efficiency challenges and driving a positive patient experience,” said Jeremy Serfling, a revenue strategy expert with more than 20 years of experience working in fintech. He joined Planet DDS as a senior product manager in 2023 and leads the Denticon team developing and integrating revenue cycle management solutions.

DSOs have partnered with Denticon, DentalXChange, and more tech-savvy companies to streamline eligibility verification and claims processing, accelerate payments, and reduce the risk of human error. That’s become especially important as dental practices face turnover and staffing shortages.

Patients want to know what their insurance carrier will cover, and what will be their out-of-pocket cost. Dentists want to ensure claims are submitted properly so they can be paid quickly and accurately for the services they provide.

Here are some of the innovative ways practices are using software solutions like Denticon to improve the RCM process:

• Eligibility Verification: Denticon’s integrated workflow with DentalXChange, a dental insurance clearinghouse that transmits EDI (electronic data interchange) transactions including eligibility and claim remittance information. That reduces the amount of time dental practice team members spend on the phone with insurance carriers.
• Multi-location Management: Since Denticon is a cloud-based practice management solution, team members can view data offsite as long as they have permission-based access.
• Tiered Fee Schedules: Team members can update a fee schedule once and assign it to the correct plan, office, and provider. This drives efficiency and ensures fee schedule consistency.
• Integrated Images Attachments: This capability eliminates the need for screenshots or switching between windows.
• Electronic Claim Submission: Team members can validate and submit claims from within the practice management system, which eliminates the need for team members to log into a third-party website to submit claims.
• Claims Task Manager: Denticon’s built-in workflow to manage outstanding claims, including task assignment to other team members, eliminates the need for spreadsheets, sticky notes, and emails, which team members have traditionally used to track claims.
• Convenient Patient Ledger: With one click, team members can see how payments were allocated across providers and offices, which makes it very easy to explain to the patient what has been paid and what is still owed.
• 835/ERA Auto-Posting Payments: With this feature, payments are auto-posted to the ledger which eliminates the need for manual insurance payment entry. Team members can also access the digital Explanation of Benefits (EOBs) which allows for more efficient follow-up on claim denials.
• RCM Reporting: Denticon comes standard with robust RCM reporting to provide you with actionable insights. All reports can be generated by group or by office, which makes it ideal for multilocation practices. These insights enable practice leaders to quickly identify and fix problems.
• Text and Email Payment Reminders: With enhanced services such as Denticon Pay, practices can send manual or automated text messages and email reminders to patients, giving them an easy way to pay online.

Payer Relations: Credentialing, Fee Negotiation, Fee Schedule Management

The RCM process typically encompasses two parts: payer relations and practice operations.

“One of the reasons why dental insurance is so confusing is because it’s not insurance in the traditional sense. Instead, it’s a benefit plan,” said Victoria Johnson, the founder of Top Tier Practice Solutions and an RCM expert who has worked in DSOs for 14 years. “It’s the employer’s choice in dental benefits plans that determines the percentage of the cost that the patient needs to pay out-of-pocket.”

Dental practices and groups negotiate fees with the insurance carriers. They negotiate what percent they’ll discount their UCR fees (usual, customary, and reasonable charge), which is what a cash-paying patient would pay, in exchange for the insurance company referring in-network patients to them.

Those negotiated fees are represented systematically through Fee Schedules. DSOs can have hundreds of Fee Schedules in their practice management system, one for each insurance plan they accept.

“When the practice receives back the Explanation of Benefits, it shows what you billed the insurance company according to your UCR, what the insurance carrier paid, which is the negotiated fee, and what is the difference between them,” said Johnson. “If the patient is correctly assigned to the correct fee schedule in your practice management system, then you receive from the insurance company what you expected to receive, and your ledger will balance out. If you attached the patient to the wrong fee schedule, then the amount will be off, and you need to write off the difference or bill the patient.”

Revenue Cycle Management Operations: Insurance Verification, Claim Submissions, Billing and Collections

The second part of the RCM process is operations.

This is the part that is most prone to human error.  There are typically six core processes involved: eligibility verification, claim submission, claim follow-up, payment posting, denial management, and patient payment collection.

Most Common RCM Mistakes with Manual Processes

• Patient scheduling and registration errors: Team members may transpose the insurance subscriber ID numbers, spell the patient’s name incorrectly, enter the wrong date of birth. All of these prevent the clearinghouse from being able to match the patient’s information entered by the dental practice with the patient’s information in the insurance carrier’s system.
• Insurance verification errors: It can take up to 30 minutes per patient for a practice to call an insurance carrier and confirm benefits. Insurance verification software companies are trying to automate this process, but it’s difficult to ensure 100% coverage because the data in the carriers’ systems is not well-organized and easily accessed. Each carrier has multiple dental insurance plans with varying rules for things like waiting periods for major procedures, types of materials that can be used, and treating pre-existing conditions such as missing teeth.
• Incorrect coding: The service must be walked out and charged out correctly, with the proper dental codes, and those must match what is submitted to the insurance carrier.
• Incorrect fee schedule: Common mistakes include not updating the fee schedule in your practice management system to reflect negotiated rates and/or assigning the patient to the wrong fee schedule.
• Insufficient documentation of services provided: All major procedures need supporting documentation, including X-rays of the teeth involved and a written narrative. Practice management systems such as Denticon provide a comprehensive workflow that includes native integration with Apteryx dental imaging software.
• Delaying claim submissions: Dental team members should submit claims on the same day as the service electronically, not through fax or mail.
• Not collecting co-pays: The patient’s out-of-pocket fees depend on the type of policy the patient’s employer has negotiated with the dental insurance company. Team members should always collect the patient’s portion at the time of service. Third-party financing solutions such as CareCredit, Sunbit, or iCreditWorks can help patients afford the cost of their care.
• Delaying payment processing and posting: When the insurance carrier issues payment, dental team members should enter payment amount and information to the ledger and deposit the payments in the bank on the same day so everything matches. Adopting the 835 process can automate much of the insurance payment entry and expedite bank deposits through Electronic Funds Transfer (EFT).
• Not following up on denials and appeals: Sophisticated practice management systems such as Denticon enable team members to instantly access aging reports across all offices, which can help you prioritize the claims that require more immediate follow-up. The task manager provides an integrated workflow for managing the tasks to resolve outstanding claims. When an insurance claim is delayed or denied, it’s typically because the carrier is requesting additional information in order to determine whether the procedure was medically necessary.

Top Tips for Effective RCM Management for DSOs

Implementing a comprehensive, consistent, and transparent revenue cycle management system includes well-defined standard operating procedures and ongoing training.

Since many doctors are paid based on collections, it’s important to ensure the payment is posted to the correct procedure by the correct provider so the doctor’s compensation is accurate. Victoria Johnson shares these tips:

• Standardize the end-of-day process
  • Assign a team member to ensure all claims are submitted for procedures performed that day.
  • Confirm that all EOBs and payments from insurance carriers have been allocated to the correct patient and the correct provider.
  • Run a day sheet that shows your cash, your credit card payments, and everything that was posted, then close out physical checks, cash, and credit card payments to ensure everything matches.
  • Go to the bank to deposit that day’s collections.
• Cross-train team members so if the person who typically handles RCM responsibilities is out, somebody else can step in.
• Look in your office drawers to ensure no one has accidentally put aside checks from patients or insurance carriers.

“It’s crazy how much money you can find in some practices,” said Victoria Johnson. “I know of one time when an office manager went out on vacation, and nobody went to the bank until she came back. Checks totaling tens of thousands of dollars were just sitting there in a drawer, instead of being deposited in the bank.”

With proper RCM processes, practice management software automation, and cross-trained staff members, it’s easy to ensure your dental group is following best practices and increasing collections and profitability.

To learn how Denticon’s practice management system makes RCM easier, click here to schedule an overview with a technology solution expert.