Billing for one dental practice and billing across a growing dental support organization (DSO) are two very different challenges. As more locations are added, consistency, visibility, and structure become increasingly important. So how does revenue cycle management need to change as a DSO grows?
A single practice may be able to manage insurance billing with a small team and a relatively straightforward workflow. Staff may know their patients, understand their payer mix, and have a clear view of what is happening in the practice's accounts receivable (A/R).
But as a DSO adds locations, providers, patients, specialties, and claims, those same processes can become increasingly difficult to manage consistently. A workflow that works well for one practice may not be practical across 10, 20, or 50 locations.
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That's why DSO billing isn't simply a matter of doing more of the same work. It requires a different approach to revenue cycle management (RCM), one built around standardization, visibility, technology, payer management, A/R oversight, and processes that can scale with the organization.
Key takeaways for DSO revenue cycle management:
- DSO billing requires scalable RCM processes to manage growing claim volume, locations, and payers.
- Standardized processes help DSOs stay consistent while allowing flexibility for unique practice needs.
- Growing DSOs need scalable billing infrastructure with the right people, processes, technology, and reporting.
How is DSO billing different from private practice dental billing?
DSO billing is the management of insurance billing and related revenue cycle processes across multiple dental practices operating under a larger organizational structure. Instead of managing the billing needs of one location, a DSO may be responsible for:
- Multiple practice locations
- Multiple providers
- Different dental specialties
- Multiple practice management systems (PMS)
- Different payer mixes
- Large volumes of insurance claims
- Patient balances across numerous locations
In a traditional private practice, billing decisions and processes can often be managed at the individual-office level. The billing team may work closely with the front office and providers, and leadership may have direct visibility into the practice's financial performance.
A DSO adds another layer of complexity. Leadership needs to understand what's happening across the organization while individual practices may still have different operational needs. This is where scalable RCM becomes important. Scalable RCM means building billing processes, systems, and reporting that can handle increased volume without requiring the organization to reinvent its approach every time it adds a location.
Why RCM becomes more complex as a DSO grows
Growth can create opportunities for a DSO, but it also introduces more variables into the billing process. The larger the organization becomes, the more important it is to have clearly defined processes and centralized visibility.
More locations mean more variables
Every dental practice has its own combination of people, patients, payers, systems, and workflows. Even when two practices offer similar services, their billing operations may look very different.
For example, one location may have a highly experienced billing team that consistently follows up on outstanding claims. Another may have historically handled billing as a secondary responsibility for front-office staff. Without a standardized framework, these differences can make it difficult for DSO leadership to determine whether locations are performing consistently or where additional support is needed.
More claims require more consistency
As claim volume increases, small process issues can have a much larger impact. A missed timely filing deadline, an eligibility issue, an incorrect claim submission, or a posting error may not seem significant when viewed individually. But when similar issues occur across thousands of claims and multiple locations, the financial impact can add up.
Standardizing processes doesn't mean every claim can be handled the exact same way. It means the organization has defined expectations for how routine billing work should be performed, monitored, and escalated.
Related: Enterprise Solutions: Flexible dental billing support for growing practices and DSOs
Acquisitions add another layer of complexity
Growth through acquisition can make DSO billing even more complicated. When a DSO acquires a practice, it may inherit more than the practice's patients and providers. It may also inherit its existing billing infrastructure, including:
- A practice management system
- Fee schedules
- Payer contracts
- Aging A/R
- Billing workflows
- Billing staff
- Historical billing issues
The acquired practice may also have years of established processes that don't align with the DSO's existing approach. Bringing that location into a larger organization therefore requires more than simply changing the name on the billing reports. The DSO needs to understand what it has acquired, identify gaps, and determine how the practice will fit into the organization's broader revenue cycle.
Standardization vs. flexibility in DSO billing
One of the biggest challenges in DSO billing is determining what should be standardized and what should remain flexible. A DSO needs enough consistency to manage its revenue cycle across locations. At the same time, assuming every location should operate exactly the same way can create its own problems.
Core billing processes are often good candidates for standardization, including:
- Billing workflows
- Claim follow-up procedures
- Payment posting procedures
- A/R reporting
- Performance metrics
- Escalation procedures
- Documentation requirements
Standardization gives teams a common framework for completing and measuring their work. It can also make it easier for leadership to compare performance across locations and identify where additional attention may be needed.
Where might flexibility be necessary?
Not every part of DSO billing can or should be handled identically. Some variables may require location-specific processes, such as:
- Specialty-specific billing requirements
- State-specific requirements
- Payer contracts and policies
- Differences in local payer mix
- Legacy systems during a PMS transition
- Workflows associated with newly acquired practices
An oral surgery practice, for example, may have different billing considerations than a general dentistry practice. Likewise, a practice operating in one state may have requirements that don't apply to another location. The goal is to create repeatable processes with room for legitimate exceptions.
When a DSO should reevaluate its billing model
The billing model that worked when an organization had a handful of locations may not continue to work as the DSO grows. Several signs may indicate that it's time to reevaluate the current approach.
- The DSO is rapidly adding locations. Growth can quickly increase claim volume, patient balances, and administrative workload. If billing processes aren't designed to accommodate that growth, the billing operation may become a bottleneck.
- A/R is increasing faster than production. A larger organization will naturally have more receivables. However, if A/R is growing faster than production or collections, it may warrant a closer look at what's driving the increase. Leadership may need to examine A/R by location, payer, aging category, or claim status to determine where problems are occurring.
- Claims are sitting unpaid. A growing number of unpaid or unresolved claims can put additional pressure on cash flow. DSOs should have visibility into outstanding claims and a defined process for determining which claims require follow-up, escalation, or additional documentation.
- Billing staff are overwhelmed by volume. If staff are spending their time reacting to backlogs rather than proactively managing claims and A/R, it may be time to examine the organization's workflows, staffing model, and use of technology.
Scaling DSO billing requires a scalable revenue cycle
To recap, we covered:
- How is DSO billing different from private practice dental billing?
- Why RCM becomes more complex as a DSO grows
- Standardization vs. flexibility in DSO billing
- When a DSO should reevaluate its billing model
Growing a DSO isn't simply about increasing the number of claims a billing team processes. As an organization grows, its billing operation needs to grow with it.
That means creating processes that are standardized, measurable, visible, and scalable while still allowing teams to account for the differences between practices, specialties, payers, and locations.
Ultimately, the goal of a scalable DSO billing operation is consistency without sacrificing flexibility. With the right infrastructure in place, a DSO can build a billing process designed to support additional locations and patients without simply adding more complexity every time the organization grows.
For growing DSOs, scaling the revenue cycle doesn't have to mean continually adding more billing staff or managing insurance billing location by location. DCS Enterprise Solutions provides full-service insurance billing support across multi-location organizations, helping DSOs take a more centralized approach to claims, insurance follow-up, A/R, and other revenue cycle needs.
Ready to explore what centralized insurance billing could look like across your organization? Book a free 30-minute consultation with one of our experts today.
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