Limoli & Associates | P.O. Box 420505 | Atlanta, GA 30342 1-800-344-2633 [email protected]

It’s “Revenue Cycle Management” and no two are the same.

If this crazy economy has taught us anything, it is that we must make the best use of what we currently have. The cost of gasoline dictates fewer and more efficient drives. Weekly adventures to the grocery store lead us to fewer leftovers and more brown bag lunches. Dentistry is no different, as both patients and employers (ours and theirs) feel the pinch of having to do more with less.

Having various types of clients in almost every state, I can share with you that many “wet-finger” dental practices are having to rethink and reshuffle their overall administrative systems. Remember, administration is optional while clinical quality is not. 

Previously, I discussed the foundational role of the patient’s plan from the perspectives of Before, During and After the date of treatment. As a result of that discussion, many of you reached out for guidance and assistance in clarifying the new economics of dental reimbursement and its specific impacts on their practices. 

Today, we need to bring in the next piece of the equation. In its simplest of terms, it is referred to as the process of “Revenue Cycle Management” or RCM. In other words – what are all the administrative steps necessary to financially collect in full (be it your unrestricted or contractually discounted) fee for the treatments rendered. 

Every process has a specific point of initiation as well as conclusion. Here is my process of both learning from as well as fine tuning your individual system of  RCM. 

With defining the specific steps, we are going to begin with the end in mind. Both the administrative and clinical teams must all work toward and know that the exact goal is to cleanly, accurately and repeatably conclude the cycle. The process is complete, and the desired goal is reached when the patients financial ledger reaches a balance of $0.00. 

Now for some of the fun and challenging parameters of building and mastering your system of RCM. 

  1. The fewer the number of steps – the better. 
  2. Once an individual component is completed it cannot be redone or later corrected. 
  3. The system will only work to be completely repeatable, if it moves in only one direction. 

Now that we have the clear objective of a financial ledger balance of $0.00 – let’s now change the landscape and determine where exactly the process begins. It is without question that the RCM process begin prior to the patients arrival. You have to know the facts of what you are dealing with in order to cleanly and accurately proceed. 

Consider starting with both how and why the patient contacted your office and is potentially requesting an appointment. 

What is the source of the patient referral or, more specifically, how did they come to contact your office? Was it another patient? Word of mouth? Specialty referral from another professional? Am I missing anything? You bet … Are they asking about their insurance? 

Do not ever initiate a conversation or ask a potential patient about their insurance. That is not your place, and it is the first step in digging yourself into a bottomless pit. You have two ears and one mouth for a reason. The patient must freely bring up this subject for it is within their context that you will learn how to mutually and successfully navigate future financial communications.

As to why they contacted your office? This is by far the most important of issues when it comes to streamlining and simplifying your system of RCM. It is here where you will learn from the patient their true level of both administrative and clinical expectation. 

So which of these two concepts (how or why) did the new patient bring up first? 

Are they wanting to have their teeth cleaned? 

Are they stating a clinical concern? 

Are they asking if the doctor takes new patients?

or

Are they looking to you for information about their insurance?

Once you have your “bookends” in place, then and only then are you ready to fill in the remaining steps of your RCM system. Oh – and just to let you know – with the exception of a common beginning and end – no single system stays the same or works for all patients. That’s why its called “management.” 

It is my honor to be of service.

Tom