Unlock potential with the fee-for-service business model: Why you still need RCM

Change is the inevitable force that propels us forward, challenging the status quo and urging us to adapt.

At a dental practice, common changes include going out of network with insurance companies, and even switching to a fee-for-service business model. 

When these changes come up, it’s natural to want to cut costs where you can, switch around team members’ positions, and use other tactics to ensure your dental practice or group is profitable. 

One of the costs a dental leader might think of cutting is revenue cycle management (RCM) providers, but that’s not a wise choice.

RCM services reduce the time between providing patient services and receiving payment by streamlining your processes using expert practices. This increases your cash flow and creates a smoother patient experience. 

Cutting out RCM services will negatively affect your dental business, even if you have switched to a fee-for-service business model.

This article will cover:

• 3 changes we see dental teams go through, and
• Why RCM services are still necessary after these changes are implemented.

Change #1. Dental teams embrace independence from selected insurance networks

There are plenty of great reasons why dental teams go out of network with insurance companies they were previously in contract with.

Here’s what a few of our customers say about why they made this change: 

• The reimbursement rate from insurance companies hasn't kept up with inflation or the industry standard
• A big, local employer has changed the dental insurance offered to employees that use their dental services
• There aren’t enough patients using that insurance to support being in-network

Some other benefits of going out of network include:

• Increased control over treatment plans, and
• The reduction in administrative burden. 

Related: In-network or out-of-network: Pros and cons for your dental practice

With fewer insurance providers to deal with, you might think you don’t need your RCM’s services anymore — but this is not true.

If anything, accurate and timely insurance verification is even more crucial after going out of network.

Our insurance verification services will inform your office of a patient's out-of-network benefits and estimate what the patient will be reimbursed. 

Having this information on hand when presenting treatment will help you communicate more clearly with patients about their out-of-pocket costs.

Our insurance verification and insurance billing experts will ensure that clean claims are submitted the first time. This reduces the amount of time and money spent following up on outstanding claims once they hit their 30-day mark.

So, what if your dental business decides to go out of network with ALL insurance companies to become a fee-for-service dental business? Let’s take a look…

Change #2. Dental teams transition to a fee-for-service business model to collect up front

With the fee-for-service business model, you collect your full fee up front, then your patients are reimbursed by their insurance companies.

For many, fee-for-service is the ideal state of a dental practice. This requires ending contracts with ALL insurance companies, officially making you out of network for all of them. 

Our customers say they love the fee-for-service model for the following reasons: 

• More and more insurance companies try to dictate treatment by the procedures they cover. When you go fee-for-service, you dictate your own treatment and fees. 
• Their team is no longer required to submit claims for procedures that won't be covered.
• They have established themselves as a leader in the area and are confident patients will stay at their practice, even if their practice is out of network for them.

Read more about the pros and cons of transitioning to a fee-for-service dental practice

We encourage dental teams to switch to this business model if they can, and after the transition to fee-for-service, our RCM services will continue to support your growth and profitability. 

Similar to offices who work only with select insurance companies, if your office isn't working with any insurance companies, our insurance verification services will help you present treatment to patients, and explain their out-of-network benefits to them.

Our patient billing services are also crucial if your office isn't collecting 100% up front for the service you are providing. As a fee-for-service office, you might provide a patient with an estimate of what their insurance will cover and only collect the difference up front.

In this case, if the insurance doesn't pay what you were expecting, the patient will still owe a balance, but your team won’t need to spend time circling back to them. Our automated patient billing technology sends reminders to patients about their outstanding balance to make sure you collect what you’re owed.

Change #3. In-house dental teams take a shot at revenue cycle management

Unlike the changes we’ve discussed so far, we do not recommend switching to in-house revenue cycle management. 

Many dental leaders initially think of RCM services as a quick fix or a Band-Aid, and they’re not.

We’ve seen this happen with our own customers. They use RCM services to clean up messy systems, and then once profits are up, they switch back to in-house billing and — guess what happens? 

If you guessed their billing becomes as messy as it was before, you’re right! Eventually, they come back to us because their unimproved systems make a mess of their revenue again, and they’ve sacrificed months of dependable cash flow.

RCM services aren’t a quick fix. They are continuous support for your revenue-related workflows. Once that expert support is removed, you’ll see your revenue and productivity decline to where it was originally. 

We understand the desire to cut costs, but it will cost your practice or group more to switch to in-house dental billing versus teaming up with expert RCM. Compare the cost of each in our Learning Center.

Expertise, consistency, and accuracy are vital when it comes to managing your revenue cycle. Inefficient systems and errors will subtract tens of thousands from your bottom line. 

Related: 3 dental billing mistakes when bringing it back in-house

With our experts supporting your revenue, even when your business model changes, you’ll see: 

• Enhanced patient satisfaction 
• Increased revenue due to fewer errors
• Streamlined workflows with fewer interruptions
• Your in-house team’s time used more productively 
• Automated processes that increase the speed at which you’re paid

Our crew of trained RCM specialists and AI-assisted processes can't be replicated in house, but you can count on us to help you from here. Even if your business model changes, our RCM support is crucial to your continued success. 

Our RCM services secure your dental business’ profitability through changes and transitions

We see dental teams go through 3 big changes: 

1. Dental teams embrace independence from selected insurance networks
2. Dental teams transition to a fee-for-service business model to collect up front
3. In-house dental teams take a shot at revenue cycle management

While the first two changes are encouraged by your revenue cycle management experts at DCS, switching to in-house billing during these transitions will harm your cash flow and cause disruptions to your processes. 

To dive deeper into why RCM services are crucial to your growth and business model changes, book a call with one of our experts.