The Group Dentistry Now Show: The Voice of the DSO Industry

Reducing AR 90+: How Technology & Strategy can Transform your RCM

On this Group Dentistry Now Show podcast, Eric Gallegos, Vice President of Revenue at InsideDesk discusses:

Why the AR 90+ issue is such a concern in DSOs?
Key challenges managing AR
AR follow-up performance from office to office
Adoption of AI and advanced analytics
Strategic RCM initiatives

To learn more about InsideDesk and their new AI digital assistant, InsideDial visit – https://www.insidedesk.com/

To receive a demo visit – https://www.insidedesk.com/request-a-demo/

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Reducing AR 90+: How Technology & Strategy can Transform your RCM Podcast Transcript. Full DSO Podcast:

Bill Neumann: And welcome everyone to the Group Dentistry Now Show. I’m Bill Neumann. And as always, we appreciate you tuning in. Going to have a great guest on. He was actually on the podcast about a year ago, Eric Gallegos. He is the VP of Revenue for InsideDesk. And Eric, I got your last name right this time. Thanks, Bill. I appreciate it. Sorry about that. Definitely the second time’s the charm here. But Eric Gallegos, VP of Revenue, and the company is InsideDesk. And Eric’s been in the industry for a while. His company is focused on RCM. We’re going to talk about that today. But Eric, for folks that may not know you or what InsideDesk does, can you give them a little bit of your background, your role at InsideDesk, and then what InsideDesk is up to?

Eric Gallegos: Yeah, of course. So as Bill said, I’m the Vice President of Revenue for Insight Desk. All that really means is sales, support, marketing kind of all run through me. What we’re really trying to do is really just create efficiencies in revenue cycle, right? How can we help our DSOs collect their dollars faster, collect more dollars, and create efficiencies and transparencies in the process. So we do that through automation. We do that through AI. We’ll talk a little bit about how we’re able to do that today.

Bill Neumann: Great. And we’re going to focus in really on the financial health of DSOs today and kind of look at that accounts receivable 90 day plus dilemma that so many, that all DSOs have to a degree. And really how, you know, what you’re seeing in the market, what solutions InsideDesk has and just, you know, overall strategies, because it’s a big challenge. Maybe we start with that. It’s a significant concern. Again, 90-day AR plus. Is it a bigger issue than it has been in years past? What are you kind of seeing and why do you think it’s such a big concern?

Eric Gallegos: Yeah, I think, look, the AR plus 90 AR issue has always been, I think, a problem for for DSOs, right? Today, there’s a lot more transparency in it, which allows them better visibility. But I think the reason it’s such a big concern today is because debt’s expensive, right? Today, cash flow matters more than it has ever mattered. And you go back a little bit with the change healthcare hack and everything that happened a few months ago, those delays in payments resulted in liquidity issues. It makes it difficult for DSOs to cover operational costs, salaries, supplies, expenses, and things of that nature. And so the reason the 90-day problem is a big deal is the things that we are seeing today when clients come to us is on average, 30% of their AR sits in a 90-day bucket. That’s a pretty significant amount of AR. And the longer that that bill remains unpaid, it’s not a secret, right? It’s less likely to be collected. And so that ends up turning into bad debt, right? They’re not going to receive that payment from the payer or the patient. And so we want to be able to really help squeeze that timeline. But when you take it even a step further, some of our clients are dealing with Medicare, Medicaid, right? And those guidelines, you have to be in compliance. So on top of potentially losing money, just from the aging, right? Noncompliance can result in penalties, legal action, right? And all of a sudden you’re stacking problems on top of each other. So anything that we can do to help kind of close claims quicker is a big, big deal for the DSOs.

Bill Neumann: You kind of look at key challenges when we’re looking at that 90-day plus. I mean, what your customers, maybe some of the DSOs you’re speaking to that aren’t your customers and may become some in the future, hopefully, right? What challenges are they really experiencing? And then we can talk a little bit about strategy. I know you have some relatively new solutions that you just brought to the market that can help out. What are you seeing as far as challenges right now?

Eric Gallegos: Yeah, I don’t think it’s a secret, right? Resourcing is difficult, right? Especially when it comes to revenue side. DSOs are growing quickly, right? We always hear about new DSOs growing 25, 50, 100 locations. And when you have that many claims to manage, it’s a difficult thing. What makes it harder on top of that is people with great DSO experience at the RCM level managing claims. are not easy to come by, right? So you are constantly battling kind of, where are you going to find these people? How are you going to train them? And it’s not easy to train. Most of these people are learning multiple PMSs. They’re learning submitting claims or follow-up claims for each individual payer. It’s just, it’s an overload, right? And there’s so much of that, that inevitably revenue, right? Claims, collections is going to fall through the cracks. So that’s probably the biggest one, right? Beyond that is just transparency, right? DSLs are trying to get more offices to join them. So you’re going to be dealing with multiple PMSs and that lack of transparency, your ability to see, right? All of your offices at scale creates a lack of communication, right? Between posting teams, between offices and centralized teams, between claims management and posting. And so what ends up happening and one of the biggest problems that happens is about a third of the claims that are in the plus 90 day bucket have actually been worked. Someone did something on it to make sure that it would close and it’s still not closed. Sometimes they’re waiting for something to be resolved, right? So the ability to communicate effectively between departments, between teams is one of the bigger issues. And then the last one is the payers, right? They’re dealing with the exact same tech stack issues that everybody else is. They’re all have different levels of maturity. There are payers today that you have to make phone calls to, right? They don’t have a great portal, right? They might not have ERAs. Some of the payers, the adjudication is slow, right? The information you receive isn’t great. And so you have to pick up the phone to make phone calls, which we’ll talk a little bit about later. And so when you’re talking about kind of the different challenges, right? Resourcing is an issue. And then when you get the resources, staffing, transparency is an issue. And then you’re always kind of fighting, unfortunately, the stack tack on the other side.

Bill Neumann: See, you mentioned it earlier when you talked about DSOs acquiring practices, different practice management software out there, and so that’s an issue. If the different practices, a big issue and not uncommon, different practices, you’re probably also seeing when it comes to that AR follow-up, different levels of success and different levels of follow-up. What’s contributing to this? And is this pretty common where a DSO will have one location that’s really doing well with its AR follow-up and then another location that is falling flat on its face? And if so, that’s common. How do you alleviate that? And maybe why is that happening?

Eric Gallegos: Yeah, there’s a lot of that, right? I mean, TSOs are growing, they’re growing quickly. We talked a little bit about insufficient staffing, new people, right? If you have an office manager who’s coming in new, right? They’re learning all your practices, maybe trainings a week long, and all of a sudden they own billing, right? They own all the billing, right? So that takes a lot of time. When you look at it on average, right? Accounts over 90 days take four months longer to close than claims that are in the 30 to 90 day bucket, right? But those four months are actually really costly. For every $1,000 in production that the DSO is expecting to get paid, those 90 plus day claims lose about $150 in the process, right? So as they’re aging, they’re losing dollars for a variety of reasons that I won’t go into at this moment. But what’s more impactful is the disparity in, I’ll just say talent or experience, right? The best offices on a 90 day claim, they’ll touch it, they close it, 18 days later, they’re done. But for a lower performing office, it takes up to two months to close that exact same claim. And it doesn’t cost them $150 in difference, it costs them $300 to $400 in difference, right, for that same $1,000 in production. And so, right, getting your people trained up is very important, but I think that’s where the automation and the AI comes in, right? How much can you alleviate? What kind of tools and tech stack can you provide your team so that they can be more successful? And you’re not dependent on talent and hiring, right? You’re dependent or more dependent on having the best tools available to your DSO.

Bill Neumann: Let’s talk a little bit about that, that strategic approach where you’re moving from having people do the work to trying to automate some of those things to free up their time to do other things. Or maybe you just don’t have, you spoke about this earlier, you just don’t have the people to do it. So moving from where it’s very, very people-centric to giving the people that are there, the tools like AI, like those analytics, to really… First, I’ve handled 90 plus, but just the entire RCM What’s the adoption rate like? Because this is all relatively new. So I know there’s like seven questions in there, but let’s talk about the strategic approach. We’re moving away from people, we might not have them, over to analytics and AI. Talk a little bit about that transition and how InsideDesk

Eric Gallegos: Yeah, look, I think, uh, what’s the adoption? It should be a hundred percent. What I, what I mean by that is, uh, if there’s anything that, that, that anybody takes away from this is, is people should be adopting some sort of RCM platform at the very least. Right. Um, adoption does a couple of things for me from a, from a, just talking about strategically, right. You, you, you plug in. And you start very, very quickly analyzing and finding and identifying efficiencies in the process. I think that’s probably the most important thing, right? You adopt it and you start going, wow, we thought we were doing well here. We actually aren’t doing as well as we thought over here. Understanding that provides resource optimization. I think that’s probably one of the most important things that we can help provide, which is understanding where you’re actually hurting and where you’re not hurting, right? We talk to clients all the time. We had these significant problems. We jump in and we go, that’s actually not a problem that you have, right? So now they’re focused on the wrong thing. So once you kind of start to understand that optimization, it’s kind of that integration you’re talking about, right? What should we be doing and how is it going to help everybody out? The reality is, is AI isn’t going to revolutionize claim management, right? It is doing that today, right? It automates tasks. It identifies claims. It’s improving efficiency. And so when DSOs leverage AI, right, all we really want to help do, not just us, but all the other companies that are out there doing it, is really just increase collections and reduce the workload on the staff, right? And so there’s a couple of different ways that AI does that, that we can help without that. The first one is just data entry. I talked to a group this week, who’s working with an insurance verification company, I didn’t even know this was possible. It’s fantastic. And After they get the information from insurance verification, they actually write back and update all the coverage tables, all the patient tables. That’s an unbelievable thing to be able to do, right? Data is key when it comes to success in RCM. And if you have different levels and different groups of people who are providing you that, it can be wrong. It can be wrong very, very quickly, right? The other cool stuff that you’re seeing groups do or software companies do is automating the claim automating claim processing, right? So all of a sudden AI can understand the best practices, understand which payers need what attachments, right? Understand how the codes need to be created and basically submit that information so they can reduce denials across the board. Again, how can we reduce the type of repetitive work that people can easily mess up as you’re writing back or inputting data into, you know, four or five or six different PMSs, right? So again, how can you do that? And I think there’s the work that we’re currently doing, right? Which is really that claim management, which is how do you prioritize claims? To this day, right, DSOs really are stomping out buyers. What’s the worst problem we can solve right now? Go fix this, go work on this, go help this group over here. We really want to be in a position where we say, hey, here are the claims that you have. Here are the claims that you really need to work on. These are the claims that are going to generate the most dollars the fastest way possible. You talked a little bit about it earlier, but we recently released InsideDial. It’s an AI dialer that calls into the payers to provide claim responses for our clients. It is an unbelievable tool. It is already helping our clients not spend time on the phones. And so all of a sudden your teams aren’t waiting on hold, right? They’re seeing the information come in two or three days later and they can start acting on it. And so that’s really the amazing stuff that AI is doing, right? Identifying not just these claims, but in a situation like ours, we’re reading the PMS information, we’re reading the payer information, we’re reading the notes that the billers are writing into, and then we’re reading the clearinghouse information, we can actually provide reasons for denials, right, suggest corrective actions, reduce denials over time. So there’s just a bunch of really, really cool stuff that is happening in the AI, in the AI and automation space. It’s not just here with us, right? It’s all across the board for insurance verification, submission, posting, and things like that.

Bill Neumann: And we actually have a little information on InsideDial. It’s on the CryptDentistry Now website. So I will make sure we link to that. But yeah, really cool solution that you have there. And relatively new for you, right? This is an added feature for InsideDesk relatively recently.

Eric Gallegos: Yeah, we have a couple of clients that have been using it for a few months now. And then we’ve recently been able to input it and connect it to our platform. And so now all those responses are in product. And so our users can see it real time. They can see the little green light when the dialer’s going out. Or I’m sorry, orange when the dialer’s going out and then green when they have the response back. We create a synthetic EOP for them and basically just line item all with the information that we were able to get from the payer to make their lives a whole lot easier. Yeah, so it’s been around for about a little over two months, but all of our clients have started ordering dials in the last few weeks.

Bill Neumann: I think we spoke about this on the podcast you did before, but I think I said this, or at least I thought this, that 2023 was the year of RCM. We have these different shifts in the focus of DSOs, and it still seems like a hot topic in 2024. What are you seeing as changes? Are most DSOs trying to look for some type of automated, analytics-based, AI-based RCM solution? Have most DSOs that you’ve worked with, have they incorporated something? I know there are a lot of different solutions out there. Or are you still seeing some that are kind of fighting it? What is your experience? I’m kind of curious because you’ve been out there for a while. I think groups are warming up to the idea, but are they are they using it? Are they adopting it? And are they making the best use of it? So?

Eric Gallegos: Yeah, I think. Look, I think the answer is almost everyone is trying something right. Are there groups out there that aren’t trying stuff yet? I think, I think that will end shortly, right? I don’t think you can be in this world, uh, doing RCM and continue to do it the old way and be successful, right? There’s too much going on, um, in the space that is, that’s really impressive and, and really, really fun. Right. Uh, most groups are doing something right. If they almost always are going to start with some sort of insurance verifications of, you know, need something like that, reach out to Airpay. Those guys are great. They’ll occasionally start with posting or some sort of submission. That’s kind of the things that you’re seeing today, which is people are using submission platforms to try to get that clean claim going through, which is pretty interesting. I think the thing that is probably the best when I consider what people are trying and what people aren’t trying. I had a conversation earlier this week with Phil Towa at The Smilest, and they are doing some really amazing stuff with AI. And one of the things that he said to me in that call was, you have to be patient. Hiring a vendor is like hiring an employee. You can’t just plug them in and expect everything to be perfect. And I think that’s really true with AI, right? I think a lot of RCM, I think a lot of DSOs who are looking for RCM solutions are looking for quick fixes. They’re looking for something to plug it in and do all the things that they need to get done. And tomorrow the revenue cycle is going to be fixed. And that’s just not the case, right? You’re going to plug in whatever process or whatever product or platform you want, and you’re going to realize that there are issues with your processes. You have to fix those processes. And in the interim, right, the product that you bought might have some opportunities in it. You’re going to have to fix it. You’re going to have to tweak it. You’re going to have to work with it. You’re going to have to train it, especially when it comes to AI. And so I think patience is a big thing for DSOs. If you can be patient, if you like working with your vendors, If you like giving them feedback so things can get better, you’re going to get some phenomenal, phenomenal outcomes. And we have been very lucky to work with groups like Gen 4 and MB2 and P4D who spend a ton of time with us and talking to us. We love listening to that feedback and making things better for our team. So people are trying. It’s a lot easier to have those conversations. It’s just where are they in their path, right? Are they starting at the beginning? Are they hitting what they think is the most biggest problem? Or are they going after kind of whatever is the buzziest thing at the moment? But I think at this point, most DSOs are pretty entrenched in getting automation into their business.

Bill Neumann: So, Eric, really, it just sounds like you’re having a lot of conversations with DSOs to help them on strategy as well, because they may be using certain solutions, but they might not have it all figured out. So there are different revenue cycle management solutions to address different parts of the revenue cycle. And they’re all a little bit different. So I can imagine it gets pretty confusing and overwhelming for groups that are trying to figure out what’s the strategy, what’s the best way. And then they all operate a little bit differently. So not every solution works for every group. So can they reach out to you or some people on your team really to kind of help them with strategy if they’re like, I don’t know if inside desk is right for us, but we need help. We know we need help. How do they really start working with inside desk?

Eric Gallegos: Yeah, I think it’s one of our bigger strengths, right? We really want to understand our DSOs that we’re working with or that we will one day work with. Look, we refer people to other companies all the time who might think we’re competitors, right? At the end of the day, people or DSOs need a solution. Our solution is not always the right solution at the right time. When we talk about strategic initiatives and when we talk about what we should be doing, we typically talk about a couple of things. Early intervention strategies are super important. Insurance verification, submission, those things are massively important to help everything downstream. When we talk a lot about continuous process and optimization, I think a lot of groups, right? They’re used to doing things a certain way. They love the way they do it. And you have to be willing to change. You have to be willing to use new things. And, you know, that’s the way you used to do it, right? Let the automation help you. But I think the most important thing that we tell everyone is leverage technology. Like leverage technology to manage claims. It almost doesn’t matter when or how, right? start with a revenue cycle software that’s gonna automate some repetitive task. If it’s claim submission, if it’s follow-up, if it’s patient posting, if it’s reducing any type of errors that accelerates revenue cycle, just start with that, right? That’s really the most important thing. You’ll start to gain so much information. But outside of that, the thing that we say everyone is implement something with advanced data analytics. Data is everything. And when you’re choosing these companies, whichever software company it is, find out what they’re reading. Are they reading the PMS data? Are they reading the payer data? Are they reading the clearinghouse data? Are they reading your user data? The more data they’re able to centralize for you, the better predictable behaviors they’re able to help you with. The easier it is to identify accounts or offices that are at risk or have large amounts of AR. And then more importantly, be able to proactively manage and help you target those opportunities. So we talk to our prospects and clients all the time. Strategy is one of our favorite thing. Let us help you point you in the best direction. Sometimes it’s us. Sometimes it’s not, but when it is, there’s a lot of things that we can help you guys do.

Bill Neumann: Excellent. Let’s take a look at and get your crystal ball out and love to hear your thoughts on maybe where the future of RCM is headed. And then what is specifically InsideDesk doing in the future? Like I said, you just launched InsideDial, but do you have any other things that you’re working on that you can talk about? But yeah, where do things go from here? It’s evolving so quickly. Where do you see RCM headed and where are you headed?

Eric Gallegos: Yeah, I think the answer is less is more. Fewer people that have to do menial work. the better for everybody, right? Your employees are happier, your outcomes are better. I think when you look at something like InsideDial and our ability to call into payers to get claim responses, I think it won’t be long before payers start taking that technology to answer calls. and have AI talking to AI. That’s the dream. I hope it happens super, super fast. I think it’ll be a lot better for everybody, right? Just as an example, one thing that’s happening. I think you’re also gonna see a lot of consolidation, right? Groups who are doing revenue cycle management are gonna start doing posting tomorrow. They’re gonna start doing follow-up. There’s some stuff that we’re working on that we’re excited about. Dial’s the most recent one. Um, but, uh, I’ll leave that for another podcast. I think some of the stuff that we’re, we’re going to have launching, uh, is coming pretty quickly. Probably the biggest one is, uh, we’ll be pulling, uh, ERAs and clearing house data into our platform. Very quickly, technically, we’re already doing it, but it’ll be general for the rest of our clients and prospects in about 35, about 30 days. And so the future is bright. It’s bright for us. I think it’s bright for the entire market. And it’s just really exciting all the possibilities that we can see in AI as we get better at it. I mean, that’s the reality of it, right? The bots and the AI is getting smarter every single day and making people’s lives a lot easier every single day.

Bill Neumann: Excellent. Exciting times for sure. Eric Gallegos from InsideDesk. Thanks so much for being here. If people want to find out more about InsideDesk or they want to reach out to you or somebody on your team, how do they do so?

Eric Gallegos: Yeah, don’t, don’t, uh, don’t reach out to me. Uh, Whitney and McMath, uh, are the absolute best. They’re the best people for you guys to reach out to. Uh, they’d love to help. You can go to our website, um, insidedesk.com. Learn about the DSOs, the products that we have out there. Um, and, uh, yeah, you can ask, request a demo from there. Uh, we’d be more than happy to help you guys out and talk to you guys. Uh, you know, if it’s the right fit, that’d be great.

Bill Neumann: Yeah, absolutely. And we’ll drop Whitney and Andrew’s email addresses in the show notes so you can reach out to them. And I’ll also drop a couple links to your most recent articles. You’ll find out about Inside Dial and a little bit more about Inside Desk on the Group Dentistry Now website. So you’ll be able to really have a good understanding and then you can, again, reach out to Andrew or Whitney and they’ll be able to help you out. But thanks, Eric. Really appreciate you joining us once again. And always a great discussion. I think we’ll have something new to talk about. I mean, we could probably do this in another month or two and you’ll have something completely new to talk about as the advancements in RCM just continue to just seem so rapid right now in a good way.

Eric Gallegos: Yeah, I think so too. I think it’ll continue to be exciting for sure.

Bill Neumann: Good. All right. Thank you, Eric. Thanks, everybody, for listening in or watching us on Group Dentistry Now. Until next time, I am Bill Neumann.