The Silent Cash Leak: Why Unworked Claims Pile Up So Fast and How to Prevent It

Speaker A: Foreign.

Speaker B: Hello, everybody, and welcome to another episode of Dental Operations Unpacked. I am your host, Jake Larson, here with my upgraded co host. You'll notice Clint's not with me. We upgraded to Jordan today. Jordan Acosta. Uh, Clint, uh, couldn't make it, but she is friends with our guest. So I was like, jordan, come join us. You two can riff on this topic all day. It'll be really entertaining. So Jordan's here with today and a new friend of mine, an old friend of Jordan's, this is Cissy Mangram. Cissy, thank you so much for joining us. We are thrilled to have you on the podcast today.

Speaker C: Well, first of all, I'm just excited to be on the podcast and today I haven't talked to anybody, so I really feel sorry for all your listeners because this will be the first time I've talked to anybody all day long.

Speaker B: So got to get all those words out. And those words.

Speaker C: I got to get words out. And for those who know me, they, they will completely, 100% be nodding their heads and rolling their and be like, uh, oh my God, we're in for it.

Speaker B: Well, there's gonna be.

Speaker A: They'll already know when they see the title and everything and who's on it.

Speaker C: Yeah, they'll be like, oh, my gosh.

Speaker B: Yeah, yeah, Sissy's the perfect person, uh, for this. Jordan highly recommended her for this topic, so we recruited her. I bugged her, text her, message her on LinkedIn 100 times and finally got her to come on today. So it's gonna be a lot of fun. So the topic today is the silent cash leak. Why unworked claims pile up so fast and how to prevent it. But before we get into that, Sissy, I know that you're just jumping at the gun to start to get into that topic. I want our those that don't know who you are to get to learn a little bit about you. So could you just take a few minutes here at the beginning, tell people about yourself, how you got into dental, and a little bit about your, your, your work history.

Speaker C: Oh, cool. Yeah. Uh, so I'm Sissy Mangram. Currently I am working at Revtech Partners. I as co founder and CRO, and crmo. Uh, for our organization. I'm helping, uh, three other founders. We all kind of came together. We all came from the world of dentistry and medical. We lived it, we read, died, did everything in it. We know how it feels. Those 14 hour days when you're trying to get things done and closing and uh, we all come from different Backgrounds. Uh, I am RCM in operations and Brett, my co, uh, CEO and co founder and partner, he's IT and finance. And then our two other founders are coming from uh, IT and finance as well. So I, I was kind of approached by them and asked, they said, come and help us build this. We need real people doing this. Um, and I said absolutely, because that's been one of my bucket list items. I feel like I need to like 100% fix the industry. I can't tell you how many times guys, I've sat sitting down at month end and go, if I can't get this report, I am going to scream. Or if I can't get this visual or I can't get this audit or I can't. I was like, this is ridiculous. We should not be living in that atmosphere at 2026. So, um, my background is in medical and dental. Uh, I did, I grew up in medical. I grew uh, up. I started doing uh, my first, very first job with birth certificates. I wrote people's birth certificates. And for those that really know me, know I can't spell. And so there's no telling how many people have misspelled names in the city of Nashville. Uh, so I got out of that and then just um, I ended up going in. I, you know, working in the industry. My, I wanted to become a doctor and um, couldn't go to school, didn't have the money. You know, there are people that have money and then there are people that don't. And I didn't have the money to do it. So I had to take some time. And between the time of, uh, being out of school and uh, going back to school, I realized that I am an operator at heart. I am a fixer. I am a person that wants things efficient. So I know that in reality if I had become a doctor, I would not be working as a doctor today. I know that. I know that. So I feel like God took me in the right direction and I love, absolutely love what I'm doing. Spent 15 years, 14, 15 years in operations, leading large medical practices and uh, doing, doing those things. So I'm fully available. Uh, I know all things operational more than I want to. Uh, and then got in, uh, I got recruited by hospital system in rcm, uh, about 15 years ago, I guess it was. Or you know, now you guys are realizing how old I am those eight years ago. Whatever. Anyway, all that to say is that was before RCM was rcm. Like that was the first time that people were starting to put together and Realizing they need operators who understood the processes of rep, of rev cycle and billing in the front office and the back office and it and all the things that involved. Um, and so they. That's how I ended up here. And I fell in love with it and I've been doing it ever since. And I came over to dental about four years ago, and I will tell you this, Jake, listen, let me just tell you. Everybody knows this story, but I say it all the time. I truly came over because I said, I'm going to sail into retirement. No more stress, there'll be nothing going on. In dental. There are only 900 codes that you have to deal with. And out of those 900, only about 35, 40 are used actively every day. And I was coming from. Guys, I was coming from an organization, orthopedic. Prior to orthopedic, I was doing heart and vascular. Prior to doing that, I was doing neuro. So I was doing some of the hardest of, uh, the hardest operational rep cycle billing you could do. Okay. And so I was like, I am totally going to sail in here. Got in. And I was like, what have I gotten myself into? So we don't have a lot of

Speaker A: codes, but we have no processes either.

Speaker C: So, yeah, that was, that was the thing. I was like, oh, my God. And then I, uh. Jake, the thing about it was, was I was like, this is exactly where God wanted me. Because at the end of the day, I am an operator at heart and I have to get things right. You know, I've got to make sure things and processes, you can't live without those. And so I think you put me in this industry to help people get there.

Speaker B: So I thought it was so that you could be on our podcasts. That was, I thought that was why.

Speaker C: Well, that's true. I mean, let's just be honest. I haven't talked to anybody all day. So I'm super excited about m being on your podcast doing all this stuff so well.

Speaker B: And this is a problem that, uh, so many operators are aware of. I love how when you're describing that, Jordan's just nodding her head, but you can also see all the scars, uh, coming through in her facial expressions from her battle wounds. Um, so many operators are aware of this, so let's dive into this. So, I mean, revenue is earned chairside. And then it goes, you know, in the claims process and so much of it is lost. So let's just talk about the general topic here. Like, why is it that claims pile up so fast and, uh, faster than anyone Else expects. What's the main problem? You see?

Speaker C: So let me back it up, Jack. Just let me back it up a little bit. Okay, Jake? Because, um, at the end of the day, if you don't really understand revenue cycle, you can't. It doesn't matter what we say going afterwards, because people will focus on these, like, areas and not realize that the problem happened over here. Right? They're going over here, they're spending lots of money over here, and they're trying to get it resolved. They're getting these denials of blah, blah, blah. And I don't realize that the problem is not here. The problem is over here. And so since I came into dental, that has been my mantra. I mean, I think Jordan probably has known that. I'm telling us, like, that's not where the problem is. You're treating the symptom. And any doctor that is dentist. Any dentist, doctor, anybody listening to your podcast, they'll understand what you mean by treating the symptom. You're not treating the root cause. You're, you know, I'm treating the fever, but I'm not really. The fever is coming from an infection. Does that make sense? So when we talk about rev cycle, we talk about claims building up in the denial process, like what we're going to be talking about today. That's a symptom of a problem, the root cause coming from another area. And until that root cause is resolved, that symptom will stay there, and that will continue to be resolved. That'll continue to be a cost, a continual thing that goes on and on. And it will. It ultimately affects your cash. So I'm going to do something really quick. I'm going to go through the rev cycle real fast. So everybody thinks the rev cycle starts at billing. Uh, like, everybody starts, oh, it's what claim submission is. It is not. It starts at contracting, credentialing, and marketing. If you don't have those three things, the best way you can do it, you might as well. You're losing. There's your silent killers right there, right? Then you have your scheduling, your front office, and then you just go through. Now everybody can go through from there because everybody's like, oh, yeah, I live that, right? If we understand where it starts and where it ends, we can find the problems that cause these silent killers and in the office that you're going to lose cash, right? And so in dentistry, y', all, I know this is going to be videoed because people are going to be like, oh, oh, here she comes. So in, let Me go back in medical. A doctor is going to charge for everything that they do, okay? They are looking to make sure they have captured everything because the margin, the margin for a doctor's office is so, so tight that if they don't charge for everything, they will lose. They will lose the game. In dentistry, the margin is like, it's so big. It's so much bigger. And so, you know, dentists are like, oh, I don't need to charge this. I don't need to do that. I don't want to blah, blah, you know, and so there's just. There's a tremendous amount of leakage in dentistry that, you know, I say this all the time. And Jake, let me just tell you, people are like, you need to be quiet, you know, don't be telling all this stuff. But there is a lot of leakage in dentistry. And I'm not saying that you need to, you know, be, oh, you know, you overdo stuff. You just should do things like it's appropriate. And so when I look at claims and I look at claims piling up and I look at silent, you know, leakage that's happening, the first thing I do is I go, this is. They did A, B, C, D, E for this patient, and they billed A and B. That's insane to me. Absolutely insane. And furthermore, your charges should match your services. That's what the, you know, Medicaid, Medicare, uh, everybody says, all the payers. But in dentistry, we don't do it. We have a lot of silent killers when it comes to stuff like that. So we'll dive more into. More into this, and I'll speak faster and everybody. But, like, having to slow it down. But, uh, yeah.

Speaker B: So I think, I think one thing that, uh, I want to just reemphasize, like you said, like, why do things pile up so much? And I think you hit on the head. Like, so many people are just trying to. To fix that symptom. And behind that is the cause. And the cause keeps shoving down garbage. And then we're like, why can't we get ahead of this? And it's because you're not willing to take those steps ahead of time. So I think that that's a great.

Speaker C: Willing to fix the actual, you know, cause of the problem.

Speaker B: Yeah. What's the top of funnel? Like, just feeding.

Speaker C: Just feeding all of it in.

Speaker B: Yeah, feeding it. And then it just piles up and they wonder why they can't get ahead of it. So in your experience, to see, like, what, what are some. I. I think this is just a fun question to ask. What are some of the, uh, like, results that you've seen? Like, how big of a problem have you seen? Create some context so the people listening can kind of say, I am this big of a. I fit into this bucket of people having this piling up. I fit into this bucket, or I'm really good at it. Give people some context from all the different, uh, places.

Speaker C: Well, first, it's very. In our industry right now in dentistry, reporting is really, really not very good. Um, and people have a hard time, so they can't even see or understand their numbers. And so, uh, that is something that, that, that is something that has to be resolved. And not only that, the reporting that comes out, that actually needs to be much better. Right? But if you were to just do by gut check. Just do by gut check. In dentistry, the highest denial, the highest denial is eligibility. And cob. That is the highest denial in, uh, the industry. So if in any one practice it is that okay? And you might say, well, sissy, this is, you know, what does it matter? Well, let me tell you what it matter. It cost you anywhere between 35 to $45 for every denial you work. Everyone. And if your highest denial is eligibility, and that is like, I'm going to just say that stupid. That's just stupid. Okay, yeah, you could totally put that in there and just say eligibility denials are the most asinine thing that you could have in 2026. There is no rhyme or reason for you to have eligibility denials. There is too much tech out there. There is too much automation. There's too much PM systems that have all this stuff. That there should never be a denial that a patient didn't have insurance or that a patient had coordination of benefits. There should never be.

Speaker A: I was gonna ask how did you. How do you recommend avoiding a, uh, coordination? Benefits denial, though? Like, what are you considering a denial, though? So, like, uh, obviously when you submit, the primary claim comes back and says, hey, this person has other insurance. Like, let us know what it is. But how do you get ahead of that? You're just talking about, like, already knowing the secondary. Basically.

Speaker B: Yeah.

Speaker C: Ah, yeah. You should already know your payers, like you should already have in your system. The primary is Delta, the secondary is Aetna. You've already decided that you did that at the beginning. You already have identified that this is your primary insurance. So the thing that I think what happens in the clinic and what I have seen personally happen in the clinic is that eligibility is the lowest thing to Be done on the totem pole. Because it's just a lot of work. It's just a lot. And so, yeah, unlike medical. Yeah. So we. I'm telling you what, in medical, there is still eligibility denials, but it is not in their top one. You know, their top.

Speaker A: It is so much easier to verify medical insurance. It's maybe not easy to understand, but easy to verify. Yeah. Eligibility.

Speaker C: There's a difference. So I tell people this all the time. There's a difference. Eligibility is. I got it. I got it. And your pm. Every single PM system in dental has the ability turn it on. Turn. I don't care who you are. If you're listening to this podcast and, uh, you don't know, and you're a doctor and you don't know if your eligibility is turned on in your PM system, then go and find out and turn it on. It's a functionality. And they will tell you if Sissy still has Delta dental, it'll say green or a check mark or a circle or something on their PM system. And that in and itself saves I don't know how much. Right. And then you have the actual benefits. Benefits are different. I'm talking about eligibility denials. I'm talking about people who physically don't have the insurance or the subscriber is wrong, or the number is wrong or the date of birth is wrong, or the care. You know, we don't know which one's primary or secondary. So we're just gonna throw it out. I've heard people, and I'm not joking you, Jake and Jordan, I know you've heard this. They'll be like, I'm gonna send the claim. I'm gonna send both the claims at the same time. I'm like, what are you. What? Well, we don't. We don't. We're just gonna say whoever pays first. I'm like, that's not how it works, people. That's. That is not the birthday rule. I was like, there are all kinds of rules involved in that. And so when I look at that and I say that that's a silent. That's stuff that adds up. Right? At the end of the day, if it's your highest denial, you are paying an AR specialist, who is, in my mind, an AI specialist, is one of the smartest people in your organization because they understand how to work those den denials. Right. They understand the problem. They understand what to do. Right. If I am paying somebody with a, uh, brilliant mind to fight denials, and they're all. They're Doing is correcting mistakes and then sending it out. That's not a good use of uh, that time. And I'm like, why would you not just fix the mistakes? And here's the thing.

Speaker A: I should be like a front desk or insurance coordinator job. That shouldn't be AR, that's just 100.

Speaker C: How many times do you have an AR specialist sitting in the billing office or sitting away, right? And they're working AR and they're doing eligible cleaning. All the eligibility, they'll do it first and they'll do it fast because they know how to do it right. But what it should do is go back to the culprit, the team, make them do it. They'll stop making those mistakes if you send it back to them. Um, plus the other thing that is, is the one that really kills me is there's, there's too much, there's too much tech out there. There's too much to say, hey, get the eligibility, get the, get the information that's related to that. Benefits are different. Benefits are different. Benefits are going to hit you with your reason codes, right? The, the, that these are not denials. And people act like they are and it drives me absolutely insane. And they'll work it like it's a denial, which even is more insane.

Speaker A: Just close it, uh, and build a.

Speaker C: And I'm just like, what are you doing? And that is your non covered services, your max benefit, your frequency, um, even authorization. If you didn't get the authorization, you can bleed on their front porch, they are not going to pay you. Okay, that is definitely, you know, but authorization is denial. Whereas you've got non covered service, you know, but I can't tell you how many organizations will work that and will fight the insurance and say no, no, no, no. And I'm like, what are you doing? If you had done the benefits, if you had done the benefit, you would have known and you would have collected at the front desk. So those are the things that pile up and they silently kill the department. And it, you know, does all this stuff, but we should get into some more, uh, deeper things that actually affect their cash.

Speaker B: I think it's just interesting because it's like I, I don't have the experience, either of you to do, having done this for a career, right? But it seems like this is so obvious. What is it that prevents people from, from making changes? Is it lack of knowledge? Is it laziness? Like what are the causes? Like what's preventing people from making these changes?

Speaker C: So I have this saying and it's kind of on my website now. And it'll always be there. And I say this all the time. 90% of denials are behavior driven. 10% are payer problems, like true payer being kind of beast, you know, can't say the word, I'll get in trouble. They're just trying to be things. But, but 90% is behavior, behavior. And so when we look at behavior, we, we do this naturally. I do this every day. I have to literally now write down things to make sure I get things that I don't want to do done. Okay. So when you are passionate about something, you're gonna do that thing. So if I'm on the front desk, I work the front desk for many years. I, you know, I know what it feels like to have 15 people and a doctor yelling in my ear. I enjoy talking to people. So, you know, I'm going to venture to talking to that person and putting the information in and having a good time doing that. I am not going to go over here and do eligibility, which is like not talking to people. And it's just data entry. It's just data, data, data stuff. And it's boring and it's, you know, whatever, right? So it's a behavior. It's like do I do. You know, it's part of my job function. But if I can't and I've heard this and I've seen this, okay, if I'm in a busy clinic and I'm in and I'm success and I'm a busy dentist and I'm successful, right, Your front office team, unless you have somebody who's dedicated to that process, is most likely only hitting the big stuff for your eligibility. They're only going to hit your, you know, your, maybe your extractions or some of your other stuff because they know that's important. But if it's just somebody coming in for, you know, their, the hygiene, they may or may not do it. Okay? So the thing is, is that today, in 2026, there should not be people literally doing this and calling patient calling insurance companies and checking websites. You, there is too much automation, there is too much tech out there to do this where they can get it. I've seen some of this tech software, some of them that are out there are getting up to 90% of it and it's accurate. So the only time they have to do is 10%. If I can get 90% of the claims and those denials go away. That is a lot, a lot of money that comes in, you know, from, from A perspective of that way.

Speaker A: But 10% is Teamsters. Local. Local union ones.

Speaker C: Um, that's right. That's right. You know, you get down to the thing about behavior is it tracks through the entire process. I hate to say it, but it's all behavior driven. And that's one of the reasons why, like, what I do at, uh, Maximize rcm, even though I have working on software, we have a consulting to help people understand the process and to get, get behind understanding the behavior. Because once they understand their behavior is causing the problem, then it becomes, then it becomes real. Right. And we have this across. Just so you know, this is not a front desk thing. I'm not picking on front desk people because she probably like, she's picking on front desk.

Speaker A: No, no, no.

Speaker C: Let me just tell you how this tracks. Okay, you ready? So I, I don't like to answer the phone. Right. So the phone might ring, and I'll be like, I'll let it ring. So I don't schedule a patient. Well, there you go. You don't have anybody in your chair. Okay. Because I don't like to answer the phone. So I may or may not pick it up. Right. There's an organization. Are you okay with me putting, like, just throwing out vendors? Or you're like, no, don't do that.

Speaker B: Go. Go for it. Yeah, okay.

Speaker C: Okay. So there's an organization called, uh, Mango, that they will freaking answer the phones for you, and you don't have to miss any calls or scan calls. So I, I, I think to myself, I'm like, well, if you got somebody that like to answer the phone, I think you should invest in Mango, my friend, because you're losing money.

Speaker A: You're.

Speaker C: This, this is the revenue part. Part for me, you're losing money because you're not getting that. Okay, so that's a behavior thing. I'm in treatment planning. Oh, uh, man, I don't want to tell them how much it is. Uh, you know, this seems like a lot. You know, they're afraid to tell people what the cost.

Speaker A: Yeah. Because you're projecting your own feelings of how much it is projecting. You don't know what they care about

Speaker C: behavior, you know, and they could have

Speaker A: been saving up for six months for this implant. You're like, oh, my gosh, I have to present this. Like, it's not new to them. They knew they needed it. They came in to get it.

Speaker C: Yeah, that's right. And, and you know, when we talk about, you know, treatment planning and we talk about that, you know, that happens on healthcare side too. I mean, you know, I mean if you've ever gone, the only time you don't really get a lot of treatment planning is if you were in some kind of an emergency. Right. Otherwise they're going to tell you what it is. Let me tell you. They're going to tell it and they're going to get it from you. Okay? The same thing happens as behavior. A doctor. Are you ready? I picking on the doctors. Here we go.

Speaker A: Do it.

Speaker C: This is where people get upset with me. But when you don't document a soap note and every doctor knows what I'm talking about and they put in their little chart I saw, I extracted and it's like, oh, um, what did you do? Because that doesn't correlate with what you build. Right? That's, that's just, that's a silent, you know, so you get all the way through by the time this claim gets submitted. It is not the billings fault when a claim does not get paid. Yeah, it's not. It's their job is to investigate when it doesn't get paid and try to get it paid. Does that make sense? So you know, when I talk about behavior, it becomes a big issue. Now let me pick on the ICM people because I know people are like, oh, sissy won't pick on them. Oh no, no, no, honey, I'll pick on the ICM people. There are a lot of RCM people out there that have very poor processes and they don't follow up in a timely manner. And Jake, those claims will 100% grow if they don't follow up. Oh, I don't like to work that particular denial because it's just a lot of work. So I'm not going to do that one today. Well, that was a $15,000, you know,

Speaker A: thing and all they needed was not evidence.

Speaker C: Yeah, all they needed was those are my favorite documentation. Or maybe they needed a, you know, appear to peer or something. Oh, I don't want to deal with that. So I'm just not going to do it. Listen, there are some really bad, bad, bad poor processes. And on, on the RCM aspect where they're following up and it drives me absolutely batty when that happens. Uh, because I'm like that's, that's just again, behavior, behavior. Right at the end of the day, behavior. Rcm, Jake, is a change management at heart department. That is, that is literally all we do is change management. That is we, we write out processes and we get people to do it. And, and we talk about, we talk about And Jordan, you probably, you probably understand. Oh, sorry about that, guys. That's me telling me I'm Wonder Woman.

Speaker B: Uh, let me. That was for dramatic effect. She's gonna drop a bomb right now.

Speaker C: Yeah. Let me tell you what's gonna happen at this point, okay? But uh, we get into this, this thing in leadership, okay? Now everybody's going to be mad at me here. And then we're like, oh, sissy, we can't have sissy here. But I truly understand change management and I truly understand there's a lot involved. There's a lot of buy in involved, There's a lot of structure involved, there's a lot of communication involved. There's a lot of that. Okay? But organizations will 100% paralyze themselves based on, we got to get everybody buy in before we do anything. And I'm like, okay, well we'll just sit here and watch your money just float right out the door. And so when they, when they tell me and they say, why is it, why can't we get this done? I said, but we're still waiting on uh, everybody's buy in to do this. So until we get everybody's buy in, we can't do it. And my type A personality is like, get it done. Like, you know, at the end of the day I used to have somebody tell me, Jake, that I was a bull in a china shop. They said, well, she can get results. Yeah, if you give her the reins, but she might destroy the organization in the process. But that's not true. I've never, never done that. But, but at the end of the day, I can tell you I've had a lot of people get mad at me. I can tell you I've had a lot of people think that my, you know, I can't do this or I can't do that or whatever. But it, uh, but at the end of the day, if your team is not willing to make the behavior changes, the claims just build up and it kills your business and it kills your silence. You know, silence all the payments and you know what I'm talking about. Join. So. Yeah, so there you go.

Speaker A: Yeah. Because you have like a thing where teams think it's going to be adding something to their workflow without realizing that it's going to be taking away three other things from their workflow. So like, oh, I have to do this new thing, I have to add something and it's like, yeah, and then you want to follow up on your 120 plus because you won't have Any like, that's right.

Speaker C: It goes away. It goes away.

Speaker A: Well, but that's harder to show on the front end.

Speaker C: So yeah, it's, it's also very difficult because you are dealing, and I, I understand this so much, you are dealing with people's livelihoods. When you start to become efficient, because what happens is I, uh, now I get to call out the executives. Hey, listen, I was in the executive team. I know what it feels like, okay? I've been there. But listen, when you start to get effective and you start to actually start seeing things go in the way they're supposed to go, for years and years and years, we throw people at the problem, okay? So. Oh, my denials. I've got a lot of denials. I need to hire more people. Well, when you start to fix the problem on the front end, you don't have as many denials on the back end. And now you've got people, right? And so aren't buying in. Those are your laggards who are not buying in to the process because they think they're going to be. Their jobs and livelihoods are going to be affected. I can tell you right now, there is no DSO out there. There is no practice out there that is actually staffed how they should be staffed in order to be an operational, high functioning team. I can tell you right now, there's none. I don't care how much money you make, you are losing money because you're not staffed. So if you've got people on your RCM team that might be lose, lose that particular role that they're doing, they can 100% be put in another role that needs, and vitally needs to be done. Do you know what I'm saying? But people don't think that way. They don't. And so, uh, that's why they get very, very scared when you do the processes, you know, stuff like that. And I can say that because I have, here's, here's some, a little tidbit of my background, okay? I have been in a very large dso, okay? Lots of doctors, lots of people. But when I was with a hospital system, I oversaw the revenue cycle for 1500 doctors and their CBO staff, okay? So when you look at that and you have efficiencies and it's scary when you go in and bring things and be, okay, this is efficient. But there are, uh, there. I can't tell you how many other things out there that needs to get done that doesn't get done because we're dealing with these stupid claims over Here that could, that are not supposed to be there.

Speaker B: Yeah, uh, I, I'm trying to, I want to steer the conversation to some like, actionable things that operators can learn from this and try to go implement. I've taken some notes as I've listened to you, Cece. I'm like, okay, I see she's giving this advice here. I'll tell you what I've got and I want you to add on to this. Okay.

Speaker C: Okay.

Speaker B: So some of the recommendations you've had is number one, right people in the right seats. I think it's wise for every operator to take a look and say, do you have the right people doing the right tasks? Um, second thing, don't fear technology. There's great technology out there that can stream a lot of this. But first and foremost, before all of those things is looking at your current systems and try to stop things at the cause, uh, or improve what's causing the problem rather than just treating the symptoms all the time. So those are the things that I'm kind of taking that behavior side, that's what I need to add. That word behavior, that behavior side, uh, that which, that also screams to me like, let's reevaluate how we're leading these teams and the KPIs and the trainings and all that. I mean that there's a whole nother episode to unpack there on fixing the behavior.

Speaker C: I'm happy to be on that episode.

Speaker B: Let's do that one again. But what would you, um, am I hitting the things on the head that you're talking about? Like, right people, right seats. Don't fear technology. Fix the behavior, fix the cause so that those claims don't pile up and allow your office to be more efficient.

Speaker C: So here's, here's what I'm going to tell you. This is the hardest things for operators. It's the hardest. And Jordan, you know this, you've been in this, you're dealing with day to day stuff. It is very difficult for a practice offer, you know, operator, somebody in a practice or in a DSO that's dealing with day to day stuff to focus on ensuring that you have the right people in the right space spot. Okay? Because it is there. It's fire after fire. It's Dr. This, it's, it's, it's month end, it's finance, it's going in, it's, it's, there's always something and you just want somebody in the chair to answer the phone. And I hear this all the time from operators, like, I need to get you, uh, know, we need to get better on these denials. And I'm like, yes, but you told the person who's scheduling appointments, don't take the insurance. Just get their name, their number and their phone number and put it in a slot. We'll get it later. Well, there you go. I mean, I don't know what else to tell you. You have to have the right people, which means you have to have the right leaders. And I'm going to. There are amazing operators out there. And here's. Here's where the reason. One of the reasons why I got out operations is because I. How do I say this without making it sound bad? Uh, I was tired of babysitting. I was like, you're doing. You're doing. You're doing your job. You know, doctors, this is what you're supposed to do. Personal do, right? And at the end of the day, as an operator, you have to have that relator personality. You got to relate. I relate with a lot of people, and I'm a very nice person. But at the end of the day, I want to get shit done. I don't want. I don't want to be dealing with all the little teeny tiny things that happen. And when you're dealing with trying to get the right person in the right spot, that means you have. You have to physically take back, sit down. Understand that position. Operators, please. If you do not know what your front desk is doing, and don't just make an assumption that you think you know what they're doing. Because I can walk into every single practice, and I think I know what they're supposed to be doing, but that ain't necessarily what they're doing.

Speaker A: Okay?

Speaker C: So you have to take the time to evaluate, once you've evaluated, find out what they really want to do. I met somebody, uh, in one of my practices that I went, and that girl could sell anything. Like, she could sell the shirt on her back for a million dollars. She had this beautiful smile, and she was just Southern is all, get out. And we had her. I am not joking you. We had her working ar. She loved working ar. She enjoyed it. But when we got her in front of a patient, every single one of our treatments would get paid and get done. And I was like, you're in the wrong role. I know you're really good at what you're doing over here, but you really should be over here. Is this something you would enjoy doing? It's just like, oh, my God, yes. I hate. I hate not talking to Anybody all day. And I'm like, that was literally like, holy crap. So you just have to know your people and make sure they're doing, you know, they're in the right role. There are dental assistants out there that are working chairside with doctors that would rather be doing treatment planning. There are front office people that are dental assistants that would rather be on chair side than working the front desk. You know, there's just, there's just, you just have to put the right people in the right places and then things start to happen from a process. So that's the first thing is taking the time to evaluate if the one thing you take away today, if you listen to this, when you're listening to this podcast, if the next week you plan as an operator to say, I'm going to go and do an evaluation of my people. And not in a check mark thing, you're just going to go and say, hey, how do you like your position? If you could do anything, what would you do? What makes you excited about what you do here? Right? What's the hardest thing for you to do? What's the hard. So like for me, for example, for me, one of the hardest things for me to do is I'm, I love big picture, think I'm a big picture kind of thinker, strategy, blah, blah, blah. When it comes down to getting down into the weeds and doing like really detailed stuff, I'm like handing that off to somebody else because yeah, I can do it and I, I'm good at it, but I would rather not do it. Does that make sense? So once you do that with your team that you can evaluate at that point, uh, is everybody in the right positions? And when people are in the right positions now from a behavior standpoint, now they're ready to be open for change because now they see where their positions of inefficient and they want to make it better. Does that make sense? So you have that. The other thing that I would tell you to do as an operator, you are running the clinic. This is anybody in operations, from a person that's, you know, office manager or administrator of the office to the senior VP or chief, uh, operating officer. Okay, you need to understand revenue cycle because there are, I cannot tell you how many people don't understand revenue cycle when revenue cycle is the bedrock of operations. And yes, I will say that because every person that walks in there is, that's the person that's going to generate you income. The doctor is the hand, the tool to get the revenue right. But everything else Everything else is the bedrock of revenue. So if you don't understand the importance of each position and how revenue is impacted by that, you know, I'm going to plug myself right now. You need to call me at, uh, maximize on a CEO. Um, okay. I'm just going to tell you. That is the deal. The deal breaker is, is that people, people in operational leadership will put people over the operations. Oh, Sissy doesn't like to do that. So we're not going to do that. Oh, Sissy doesn't want to. You know, I'm not going to do that because she's. She does. She told me she's not doing it. Well, there you go. There's your. There's your. There's your silent revenue late, because this person is dictating whether or not you're going to get what you need for the revenue on that. I'm not trying to be mean now. I know people are going to be looking at this, rolling their eyes. It's like, sissy, you're mean. I'm not like something that I realized, Jake, since I started Maximize RCM Consulting, which has been something that I've always wanted to do, but just was like, I got to help processes, right? Was. I had this funny, weird thing happen to me. I've had CFOs call me and COOs call me confidentially. They don't want anybody knowing. And they're like, I need you to tell me how revenue cycle works. And I need to understand that when my revenue cycle leader is talking to me, what should I be asking and what should I be looking at? And I'm like, absolutely, I'll help you. And then I think to myself, how many people are operating that way? How m. Many operators, how many COOs in dentistry right now? And people operating with the fact that they think they know rcm and in reality they really don't, but they're afraid to ask. You're afraid to ask anybody, you know, so it's been kind of a fun thing to do because that's, you know, those are the kinds of things. It's like, okay, we just do that stuff. So, yeah,

Speaker A: one of the largest CSOs I worked for, um, early in my career when I was an office manager, I got, like, talked to about my denials percentage. It was like they were calling it denials, but it was like frequency over max. Uh, that kind of stuff.

Speaker C: Yeah.

Speaker A: Or, uh, not covered, whatever. Um, and if you look at the actual patient accounts, there's no balance, because I already knew that ahead of time. And I was collecting up front, putting in the treatment plan, like adjusting the payment. So it'd be like, okay, fluoride's not covered because you're over the age, so I'm gonna put it over here and charge you for it. But I'm still going to bill it to insurance because that's what you're supposed to do. And then I'm like, these are not denials. If you go look at the balances, they didn't create balances. I knew ahead of time, like, I'm doing my job extra. Ah, awesome, actually. But then, like, the people who are running the org don't know that. I mean, I guess there's not really a way to tell there's a balance from a denial. But it was wild to me that I had to, like, defend that kind of stuff to people who have C titles.

Speaker C: Here's the wild thing, Jordan. Here's the wild thing. I was speaking at a conference and I said, people need to understand the difference between a denial and a. A reason code. Right. And I said that earlier in this podcast. Right. And people were like, well, non coverage of denial. It's like, no, no, it's not. And there are. There are systems out there. There are systems out there. I'm not mean any of them, but there are systems out there that classify these reason codes as denials. And I was, I was looking at one system and I said, those are not denials. And they fought me on it. And the payer is never going to pay. Never. So I tell people all the time, I'm like, if a payer is never going to pay on it, it's not a denial, it's a reason code. They're telling you, hey, hey, sissy, go bill the patient. They are the responsible party. They're not doing it. And so when you go to put these reason codes inside of your denial percentage, Jordan, which is what you were talking about, throws away, they think they have a 10% denial code, you know, and they're like, oh, my God, my denials are 10%. But when you take all of those out, it's more like 2% or 1%.

Speaker A: And then you can identify the actual office with issues instead of just now at the front.

Speaker C: Yeah, but you know, one of the things that I do do, though, is I do track those because I want to see if they're a, uh, Jordan, I want to see if that person on the front desk is collecting that money because the money is going to show up on the patient ar.

Speaker A: Right.

Speaker C: If they don't they don't collect it. And you are so spot on. I can't tell you how many people I've talked to that have. Are leading organizations and they can't even understand that basic of, um, information. And how do you, as an. As a leader. So Jake, you know, you're like, how does she get on this? You guys can cut this all out if you want, but how do you, as a leader, lead an organization and not understand your report recording and not understand how to do stuff? Because you may or may not be acting on things that are appropriate, you know? And so. Yeah, so I don't. I think I went off on a tangent, but yeah, there you go.

Speaker B: No, I. I'm just. I'm thinking about this, the. The topic. Right. I'm going kind of coming full circle as we wrap this up as we get close to time here. The silent cash leak. Why unworth claims pile up so fast. And as you hear, uh, Sissy's experience, Jordan's experience, there are. There's so many different things at the top of the funnel that are causing this that, uh, I do think that we're gonna have to have a second episode talking about, like, how to actually some. There's probably no silver bullet, right. But what are some things that you would advise people to actually do and change? We talked about a few of them, right. Some things that you could do today, uh, evaluate your people. Do you have the right people in the right seats that can be excited about it, passionate about it? Those things can help, um, don't fear technology. Um, fix the cause. Right. Implement some trainings and things like that. We did an episode with a friend of ours named Taylor Ashcraft from Accelerate Dental a little while ago, and she talked about some of the processes that she's put into place. Really good leader helping fix these things. So that I would. Do, you know, Taylor.

Speaker C: Yep.

Speaker B: Okay.

Speaker C: I'll tell you when, when, when people understand the processes and put them in place, that's when you start seeing.

Speaker B: Yeah.

Speaker C: Real results. But I wanted to tell you one thing, Jake. There's one thing that if people can, uh, do today, and they're welcome to reach out to me and I will send this to them free of charge. I don't care. Just. Look, I'm. I'm all about let's get it right. Okay? But if you don't have a report, and I can guarantee you most people don't, like, probably 90% of the industry does not have this. Well, you can draw a report of your denials out of the system, you can track that manually. And I have a really great spreadsheet that I use that an AR specialist just has to drop codes in and it'll do all the fun fantic magic. And that's something that I would say today. If they didn't have that or they don't have it or they're in an office, I'm happy to send that to them and then they can start tracking that stuff. And now you have, now you know where your root cause is and then now you can go.

Speaker B: Right. What would be the best way for people to get in touch with you that want to chat, learn more? Um, get that resource. What would you recommend?

Speaker C: I would say, uh, you know, jump at the highest podium and scream my name. I'll come running. No, uh, my email address is sissy cissy.mangram m a n g r u m m@revtechpartners.com or @maximizercm. Um, they can go to our website as well. Um, I will preface this. At this time, at this moment, I don't know when this podcast going out, but we're in the middle of revamping our website. So it looks a little crazy right now. But, um, you'll be able to, you know, go in there and, uh, reach out. I am very active on LinkedIn, so I would say get on LinkedIn, connect with me and then send me a message because I am probably, I have it always up, so I always know when somebody's coming in or, you know, and so, um, that is probably the best way. Uh, you know, you can call me if you want. I'll give you my phone number. 615-397-5042. Now everybody in the morning.

Speaker B: Why did you just say Jordan's number? That was.

Speaker C: I was like, I was like, why is that? Oh, you know, I, you know, text me and tell me you heard me from podcast. But yeah, so, you know, any of those options, you can, you know, you can find me, I'm out there. You can just look me up.

Speaker B: Well, thank you so much for joining us. We'll definitely have to have a episode, uh, 15B since we'll have a follow up with and get into some of these behavior changes. I think there's a lot of really cool things should be really meaningful to get into that. But it's been, it's been awesome to chat, learn from you, uh, hear your story and we, we really do appreciate you taking time with us today. Super kind of you.

Speaker C: Yeah, you're welcome.

Speaker A: I.