Alec Goldman (00:27.658):
Welcome to How I Grew My Practice, a podcast presented by NexHealth. I'm your host, Alec. In this episode, we have Sina Amiri, VP of Revenue at Zentist, here to talk to us about how to enable your dental revenue cycle management with artificial intelligence. Sina, welcome to the show. How are you doing today?Sina S. Amiri (00:31.257):
I'm Fantastic Alec, and thanks a lot for bringing me on your show.Alec Goldman (00:57.742):
Of course, thanks for being here. For all the folks who may not know who Mr. Sina Amiri is, Sina, if you can just give us a little bit of background about yourself and what you're up to over at Zentist.Sina S. Amiri (01:08.179):
Sure, so Alec, I've been in the healthcare industry since 2005. I started my career in medical software, primarily working with hospitals and health systems and evaluating and implementing healthcare IT solutions was kind of part of that consolidation trend in medical. And then in 2012, you know, saw what was happening in the dental industry and ended up joining a consulting firm that had both a dental, medical, and a veterinary division.
And on the dental side and veterinary side, the company was partners with Henry Schein Dental, so had a lot of exposure to thousands of customers across North America through that partnership. And I realized, you know, as I was getting into the industry on the dental side, that consolidation was gonna start to happen, right? And so I had the opportunity prior to joining Zentist about two years ago to basically help form a DSO, a dental support organization, raised private equity around it, and then was part of the growth of that DSO. And so I sit where I am at Zentist now through the lens of a former operator, and was really curious to see how the RCM, the revenue cycle management market within dentistry would evolve, and having come from the medical industry where it is such a pain point for medical providers.
It was just a matter of time before there was technology innovation brought to market. And so I think we're in the early innings of that cycle, that innovation cycle, and we're just starting to only see what's possible with the existing solutions.Alec Goldman (02:53.038):
So when people come onto the show, the first thing I always ask is, you know, what's the one topic that you're super passionate about that you think is going to be most valuable for our audience? And when we were speaking about it, you said not only is the technology within dental revenue cycle management so important, but we're seeing kind of artificial intelligence make its way into the technology. So first question, why was this the topic that you wanted to speak about today? And then if you can kind of just give our audience
a little bit more detail of what exactly is dental revenue cycle management.Sina S. Amiri (03:28.947):
Great question, Alec. So I would say that prior to DSOs growing, right, the term revenue cycle management wasn't a common term in the dental industry. And reason for that is generally, if you talk to an independent practitioner and you bring up RCM, they probably wouldn't know what the acronym stands for, but they'll know what you mean by dental insurance billing. So it's important to recognize that revenue cycle management is much more than just
billing a patient, right? Revenue cycle management is really the financial circulatory system of a DSO or a solo practice. And it really begins when the patient reaches out to schedule an appointment. So for example, they could be utilizing NexHealth to book that online appointment. And that's really where the revenue cycle starts. And it only ends when you've collected all of the payments for the appointment and treatment that's been rendered.
And without revenue cycle management, dental practices wouldn't be able to pay their suppliers. They wouldn't be able to really employ people, right? Because if you look at the average practice in the US, anywhere between 60% to 80% of their total revenue is tied to payer reimbursements. Now, for those of you that have a fee-for-service practice, kudos to you. But in a lot of geographic markets...
where the prevalence of dental plans is great, patients generally ask when they call or when they wanna book their online appointment, will you accept my dental plan? And I think that's why it's become so important, especially now when you have layoffs happening and for those that have a spouse that has a plan, people really want to take advantage of the existing reimbursement dollars.
and minimize the sort of discretionary spending, right? And although we love to think about dentistry as necessary care, unfortunately, many patients believe that if it's not an extraction, right, everything else is an elective sort of procedure. And so we have a long ways to go and convince patients to pay for that treatment upfront in cash using their own funds. And for those that are employed
inflation for food and other expenses, they're ever more reliant on these dental plans going forward. And so we think that it's such a critical component of the financial health of the clinic. And we believe at Zentist that every dental group and every dental practice is a dental environment cycle management organization, because without dysfunction working properly, you're going to run into all sorts of cashflow issues.Alec Goldman (06:17.09):
So it sounds like, I mean, it's really the money coming in. And that starts to your point with appointment scheduling. That also, I believe, touches in on insurance verification, claims processing, the payment processing, and then likely the analytics that sit over all of that to ensure that your practice or collective practices of the DSO are getting paid on time.Sina S. Amiri (06:39.515):
Absolutely. And we can get into Alec, if you want, you know, why technology is playing a more critical role within RCM as well. So an area within artificial intelligence, which is basically referred to as text mining or text analytics, uses natural language processing to transform the free sort of unstructured text that you see in documents. And by documents, I mean, explanation of benefit statements, right?
You know, most practices are either logging into a payor portal to download these explanation and benefit statements, or they're opening the mail. And the utilization of text mining and analytics has great use case in dentistry in revenue cycle management because you can extract a lot of information from these, you know, non-structured documents and turn them into dashboards that you can now utilize.
To do things like manage your claim denials without having to log in to 55 different insurance portals to manually interpret these EOBs. And for a lot of practices, this savings in administrative time allows them to just spend much more time with the patient rather than staring at a computer. Because how often do we hear, right? When patients check in, I don't want to be greeted by somebody who's not looking at me and is looking at a screen. And so... a lot of patients wonder what is the administrator doing behind the screen? Well, part of what they're doing is looking at things like eligibility, determining whether or not the patients qualify for the treatment through their dental plan. And the more that we can, I think minimize the screen time by having this information presented in a very digestible way, the better the overall patient journey is going to be.Alec Goldman (08:28.334):
So, I mean, you started clearly just touching in on this of how AI is making its way into RCM. But what are additional ways that DSOs could be leveraging artificial intelligence and even just additional technologies to enhance the effectiveness of revenue cycle management?Sina S. Amiri (08:46.707):
So one area that we look at is some practices are currently just logging into many different websites. And as you're probably familiar, Alec, the use case for robotic process automation has a lot of value within the industry when you're going through repetitive tasks, like, for example, logging into the bank account to see whether or not the payment from Delta or Demeril was deposited.
And then does that payment, that $620, does it actually match the treatment that was rendered to Jim Smith? And so we're utilizing at Zentist a combination of text mining, robotic process automation, and artificial intelligence to basically, rather than having a number of humans log into these bank portals, log into the payer sites, to find this payment information.
To bring it all together so that you're utilizing your team for the more creative tasks. Or for example, negotiating the fee schedule, right, with the payer, which requires a human touch. So the higher, you know, touch kind of tasks, I think those can be much more concentrated and have your team focus on those rather than the repetitive motion of having to make 55 different clicks to get to the data that you want.
And so I think these technologies have the ability to, again, give back time to the dental clinic. And we know a lot of the doctors are today struggling with finding qualified front office team members. And so from that perspective, we think this will cut down the amount of time that those front office team members have to spend training, frankly, on how to understand the different nuances when it comes to dealing with payers.Alec Goldman (10:43.97):
So we see, I mean, I hear this all the time, specifically from individual practice owners, certainly from DSOs as well, but really focused on, I guess, the individual practice owner, that when you have an area of, I don't wanna say, I guess, the opposite of expertise, where you may not have expertise, the instinct is to outsource, right? So if you think about something like a content strategy in marketing, you typically will see dental owners,
find a marketing agency to help them get their name out. When it comes to revenue cycle management, when should a DSO consider either centralizing and doing it themselves or outsourcing some of this work specifically so they do not get caught or left behind with outdated technology that may not have some of the AI that you're speaking of?Sina S. Amiri (11:33.479):
So I think it's important to determine for this question whether or not we're speaking about a solo practice. So a non, let's say DSO affiliated practice versus a DSO. So the majority of solo practices would probably agree that dental insurance billing, right, may not be their core competency. And as such, they may opt to outsource that.
For a percentage of insurance collections or for a flat rate fee. And so I think the first question you have to ask yourself as the owner-operator of a solo practice that's not DSO affiliated is, is insurance billing right? Something that we're great at. Could somebody do this better than we can? So looking at your first pass rate on those claims submissions, you know, if you're seeing high degree of resubmissions and denials and you just don't want to be bothered.
With learning how to improve that. And you frankly don't think your time is best spent on that. You can opt to outsource it. And if you do outsource it, right, you have to ensure that the third party or the BPO services organization is actually doing a better job. So I think it's really important when you're considering whether or not you should outsource to have some sort of a baseline. What I see happen a lot is providers decide to outsource, but they had no baseline in terms of looking at existing performance of their billing operations. And so when they outsource, they can easily say, criticize, right, the third party organization for making mistakes. But what if, you know, your own team was making more mistakes? And then on the other end, if you don't have that baseline and you're actually doing a much better job than that organization.
That's something that you want to know going into the relationship. And for DSOs, many times they're going to the independent practice owner and they're saying to that doctor, you know, we can do a much better job when it comes to procurement, we can do a much better job when it comes to insurance billing and dealing with HR related matters. And so the question I often ask the DSO is what is your brain promise to the provider, right? If you're going to the community and you're saying to that doctor owner, you should affiliate with our DSO because we're great at removing friction within the insurance billing process, then you better be good at that particular task, right? Because if you don't deliver on that grand promise, your reputation is going to get impacted. So I don't think that DSOs should try to do it all. I think they should really determine
how they're gonna differentiate themselves from other DSOs. And once they determine that, if they, for example, are promising we're gonna get you new patients and marketing is a brand promise, then you have to get really good at that internally, right? You can decide to outsource some parts of it, but there is gonna be a cost associated with that. And when you consider that a lot of DSOs have management fees that they're charging clinics in exchange for rendering services, you have to understand that if you're say collecting a 10% management fee, right, legally, you have to be delivering some services for that. And that market rate has to be justifiable. Otherwise that management services agreement could get challenged, right? Meaning the Docker may say, why am I paying this 10% management fee? If all you're dealing is just dealing with a consortium of third parties, uh, with very low management on your end.
And so I think there's a legal implication as well to that decision. Once you decide it needs to be a core competency, a mistake that I often see with DSOs is they try to do it all rather than kind of breaking the revenue cycle into its specific stages and incrementally tackling each of those steps. So as an example, right, you take the first step, which is patient registration, you know.
What does that break down into, right? It's appointments getting scheduled, what information do I need to record from that patient? And maybe some of this information can be collected using say NexHealth. And then the next stage would be insurance verification. So I'm looking at getting details in the practice management system, I'm determining whether or not the patient has sufficient coverage and then I'm getting the patient in the chair, we're presenting the treatment and I'm getting acceptance of that treatment.
And then we're submitting the claim and then we're posting the payment and we're working AR or we're focusing on patient collections. That's seven steps right there. And you have to really hone in on what you're wanting to improve because if you don't focus on, let's say, claim submission, right? And you just simply focus on patient registration, well, there's no wonder that you're not gonna be able to improve the, let's say, the claim submission.
effectiveness. Now, there is a downstream effect with regards to verification of insurance eligibility, right? And the intake of the information, the quality of that information is going to impact whether or not a claim is going to get accepted or denied. But I do believe that you have to really break it down into the various steps and then focus on one area at a time. And if you have the benefit of having a larger team, maybe you can set up work groups that tackle each of those steps.
And then the other, I would say, you know, misconception or mistake that I see happen is a lot of times that DSO has this idea that we're going to have one system for everything. And I'm sure you all deal with that a lot at NexHealth, where there is an over dependence on the practice management software, right, to deliver it all. And you'll be waiting a long time if that's your expectation. So what you want to be looking for are tools and technologies that can help improve your practice management software workflow, whether that's through an existing integration or whether frankly that's an application that sits outside of the practice management software that you're logging into to obtain additional data that you would normally have to go to eight different portals to obtain.Alec Goldman (18:07.138):
So when you think about technology to perhaps, or now innovative technologies to support RCM, what are some of your top technologies that come to mind that DSOs would certainly benefit from so that they're not just solely relying on perhaps one system?Sina S. Amiri (18:23.283):
So I think it's very common to see today, anyways, practices looking at technologies like, for example, if I'm diagnosing treatment, am I using X-ray analysis software to determine whether or not this particular patient requires the treatment? So if you're submitting to CLAIM, the more evidence you have with regards to the necessity of that procedure, the less likely it is that claim is going to get rejected. So I think one set of technologies that has seen greater use case today, thanks to advancements in computer vision, is the ability to utilize X-ray analysis software in order to interpret these X-rays. And then you can still have a clinician obviously take a look at it, right? But this kind of helps you see the force from the trees and it's going to reduce the manual interpretation of those X-rays. And then on the claim submission side, there are tools and technologies that allow you to determine whether or not you have the right attachments when you're submitting a claim. So it basically automates the information collection at the claim submission stage by basically determining what type of procedure is this.
looking at the procedure codes and then for that particular payer, here's what we know, right? That payer requires for this type of procedure and if we include this information, it's going to increase the odds that we're going to see the claim get accepted the first go around. And then once the claim has been submitted, if it's denied, we're seeing a lot of analytics related applications that are giving you a breakdown of those procedure codes and denial codes and it's basically classifying the action details, like for example, resubmit the claim or drop the balance of the patient portion. And so those technologies that are much more denials management related, allow you to automate the next steps, right? Once that claim gets rejected. And then on the AR management side, we think that there are definitely great tools for patient collections, meaning, there are tools that you can use like NexHealth that allow you to communicate with the patient, right? With regards to the existing, let's say, balance that's owed. And you may want to have your online forms at the patient registration stage also automated. Where I haven't seen as much progress would be with regards to insurance AR. And many times that process within the clinic is highly manual today. And there are tools that allow you get a better visual of your existing AR, the challenge with a lot of them is they're reliant on a practice management software integration. And historically, the practice management software vendors have been a bit more defensive with regards to opening up general ledger access and claim level access within the practice management system. And so we're finding that there is difficulties with a lot of practice owners in terms of just working the AR.
That's why oftentimes it becomes outsourced to a third party, and they go through it manually, claim by claim.Alec Goldman (21:54.338):
So, Sina, you know a ton about RCM. I guess what brought you to Zentist? What makes Zenthis a little bit different than perhaps some of the other insurance platforms that are out there?Sina S. Amiri (22:04.307):
So I think one of the things that really attracted me to the company was how long Zentist has been in the market. So the company was founded in 2015. It was the first to offer a modern cloud-based revenue cycle management software. And today, we have more than 40 of the fastest growing DSOs using our flagship product, which is called Remit AI. That's over 1,000 clinics that's represented in this 40 unique organizations from a perspective of just market adoption and kind of a proven tech stack, it's already gone through this iteration process to the point where private equity backed DSOs have proven it delivers efficiency gains within insurance payment posting operations. And then the other thing that really differentiates Zentist is the fact that we have the widest dental pair coverage in the industry. So we today are parsing, right?
More than 200 different EOB types. And what I mean by that is there's a list of more than 200 payers where instead of you logging in manually to download the explanation of benefits statement from the payer portal, our bots will do that for you automatically. And then we parse the data, we standardize and normalize it onto a single dashboard. And we map all of the different EOB types to one format. And I think that's very unique in that other vendors haven't been able to do that for that many payers. And on top of that, we're leveraging what is called ERA, or electronic remittance advice, ERA 835s. We're aggregating ERA 835s across more than 500 unique payers. And this combination of you'll be parsing and ERA data aggregation is the widest today in the industry as far as coverage. And then the last thing that I think makes them to stand apart is we have a huge,
AI ML engineering team that's solely dedicated to improvements within insurance revenue cycle operations. And we're taking the most difficult problems within that realm. And we're building technology solutions. And although there are a lot of great engineers right across NexHealth and other organizations, because this team is so highly focused on revenue cycle management, we think that our ability to bring new innovations to the market is going to exceed that of other vendors, which frankly are not as focused on revenue cycle management. But I do believe there's a need to kind of bring all of these solutions together so that they talk to each other and collectively can allow the provider to deliver a much better patient experience.Alec Goldman (24:48.014):
So from just to be from my perspective, it sounds like there's tools for the patient experience. Certainly NexHealth does that from scheduling forms. All of that information is then gonna be leveraged for something that Zentist would then use to actually verify the insurance, which you guys are really diving into the AI component to actually have the insurance verified at a much more highly efficient way, ideally decreasing head count.
making the dental service organization much more efficient specifically when it comes to the RMC process.Sina S. Amiri (25:23.279):
I just want to clarify Alec that for eligibility verification, it is not something that Zentist is currently focused on. Where we really pick up is once the claim has been submitted, we bring you the denials management analytics, and we also assist with reducing your feature AR by ensuring that the minute the denial occurs, you're taking action on it through the data intelligence that we deliver. And then on top of that, we reconcile the bank deposits against the remittance data. And this eliminates the need for manual EFT trackers and lockbox reports for DSOs. And then for solo practices, it eliminates the need for an administrator to log into the bank account and go through and read every transaction to determine whether or not Delta or Cigna paid you what they were supposed to. So that's what we currently are.Alec Goldman (26:16.75):
So that makes sense. So it's not fully automating people, it's just making them much more efficient with their time. You guys are giving them the right data to understand the steps that they need to take so the second that they log in, they understand what claims they need to push forward, what needs them, which ones they have to make phone calls for relative to the world that they live in now, which is tons and tons of hours just waiting on the phone, trying to figure out where things sit per patient, per service almost.Sina S. Amiri (26:42.531):
Absolutely. And we have really automated insurance payment hosting where there's a lot of work to do. It would be on eligibility. But I would argue that right now, right. Even with the greatest technologies that are available. It doesn't completely eliminate the need to call the payer. So that use case, you know, is very difficult to automate at this point. And so we think that a combination of human capital and technology is what's required to solve that.
But it's not something that we're currently focused on because we think there's so much improvement you can make in the revenue cycle process by taking what's highly repetitive, which is insurance payment posting and bringing automation to that world. And that part of the revenue cycle is what it affects your bottom line because you could be getting paid by the insurance company, the claim gets denied, but if the claim is denied, you don't get in front of the patient quickly enough, that gets into your plus 90 day aging bucket.
And it's going to be very difficult for you then collect the outstanding balance from the patient. So I think this is where the combination of let's say remit AI, right. And tools like NexHealth can deliver significant value without trying to solve it all because I said earlier, you really have to break it down into its separate components.Alec Goldman (28:01.134):
So certainly coming up on time here, but I would imagine that most DSOs are, A, not going to want to outsource a lot of this. They're going to say, we think that we can own pretty much all of these different pieces of revenue, collections, insurance, et cetera. What would you say to a DSO? What are the metrics that they should be considering to assess where they should start in this process, given that there's so many different steps?
How should they be thinking about prioritizing?Sina S. Amiri (28:34.287):
Again, great question. So some DSOs, they have specific roles that are dedicated to such things as eligibility verification or dealing with, say, claim denials in AR. So I would start with looking at your internal setup to determine, do I have the right people assigned to the right revenue cycle tasks? And do I need specialists?
So like, do I want to maybe have somebody specialize in working with a specific payer because that comprises of 20% of my total denial volume as an example. So I think it starts with an as is assessment of where you currently sit and looking at your first pass rate on those claim submissions, looking at your AR buckets and doing a holistic assessment and then determining do I have the right people, right… inside my organization that can help improve these metrics. If you don't, this is where the decision to either hire somebody or outsource comes into play. Unfortunately, given how quickly the dental industry has been consolidating, there is a huge wait time for finding qualified revenue cycle management leaders. Like the average RCM manager today, if you post a job ad, it's gonna take you approximately 200 days.
It's for somebody that's at the manager, director, VP and above level to basically fill that role. Right. And so the reason we believe is because historically you didn't have the formation of DSOs. And so all of a sudden with all of the DSOs in the market looking to internalize revenue cycle management, there is a huge amount of demand for talent to the point where, you know, a lot of DSOs are having to come to the medical industry and basically... take somebody who works for a hospital health system in ref cycle management and bring them over. But those individuals don't have the dental experience, right? So they're having to learn a lot of these things. So I do believe there is a value in looking at vendors and companies that can help you along the way. We might not necessarily be, you know, a long-term commitment. It could be that we're gonna hire an interim executive or we're gonna hire this vendor for the time being until we decide.
we're gonna build a central billing office, right? Or until we find this director of revenue cycle management or IT person who may want to build this stuff internally.Alec Goldman (31:05.666):
So, you know, we are at 31 minutes. I wanna give you kind of one last opportunity. If there's anything that we have not covered within regards to revenue cycle management, specifically with artificial intelligence, that you'd like to share with the audience before closing up.Sina S. Amiri (31:19.975):
So one of the initiatives that Zentist has started, given the lack of education and knowledge within the dental industry as it pertains to revenue cycle management, is an event where we bring together leaders within the revenue cycle, both from DSOs, as well as those that work at vendor organizations, whether it's clearing houses, practice management software companies, and RCM companies. We bring all these people together and we basically discuss what are the current challenges within revenue cycle operations? And we have panels and work groups that are dedicated basically to these topics. So we hosted two revenue cycle management boot camps in the past and they were extremely successful. And I'm delighted to say that we're going to host another one November 8th to 10th in Scottsdale, Arizona. That's 2023. So you can go to zentist.io
to find out more information.
And the reason why I think this is really valuable is because prior to Zentist hosting this conference, there was no dedicated kind of forum that was very tailored to multi-site operators and how they can address the current manual and technological challenges around revenue cycle. And we've had RCM leaders that have been able to connect with other DSO professionals and just share their knowledge and resources and be able to call each other when there's problems that arise. And I think that mentorship and networking is highly valuable, particularly in an area where there hasn't been a lot of conferences that have been solely dedicated to this topic.Alec Goldman (33:00.654):
For those who are interested, go check out zentist.io
. Those dates were November 8th to the 10th was what you said.Sina S. Amiri (33:07.939):
November 8th at 10 in Scottsdale.Alec Goldman (33:11.331):
Awesome. Sina, thank you so much for joining. It was awesome. I certainly learned a lot. It'll be really awesome to get you back on here. Hopefully, just let's call it past summer. But I think there's a lot of really awesome insight that everybody's going to learn a lot from here.Sina S. Amiri (33:27.747):
I appreciate your time, Alec, and I hope everybody found this podcast insightful. If I can be of any help, let me know.