The average dental practice has a collections percentage of 91%, with a whopping 18% of past due accounts receivable. Up to one-third of dentists are also facing decreased reimbursement rates. In addition, insurance reimbursements have failed to keep up with rising costs, putting increased pressure on practices to optimize cash flow.
eAssist leverages the collective power of human expertise along with Copilot, the company’s finely-tuned artificial intelligence (AI) tool, to eliminate these billing headaches. As the company’s Chief Technology Officer, Jason Orgill explains, pairing AI software with highly trained personnel is key to the success of this endeavor.
Understanding accounts receivable challenges
In most practices, generally, the first 90% of claims are straightforward, while the remaining 10% are typically denied. This last 10% becomes a subtle and gradually increasing problem. Accounts receivable can snowball each month, eventually hitting filing limits. These outstanding balances affect a practice’s financial scorecard, diminishing its working capital and straining office staff.
With many practices operating within razor-thin margins, improving revenue collection is essential.
Source of claims denials
The ever-evolving web of dental policy rules and dental codes makes submitting claims a complicated task. “The more complex the dental procedure, the more variation we see in how insurance carriers handle each procedure,” says Orgill. “It’s challenging for practices to properly provide the support needed to get these claims paid.”
That’s where eAssist Copilot comes in. eAssist supports more than 3,000 dental practices in managing collections, saving them money since having their own full-time staff do it often costs more. Beginning in 2023, eAssist augmented its dental billing specialist team by developing AI-powered software called Copilot. This technology works with a dental office’s practice management system to automatically review claims for potential coding and billing errors before being submitted to insurance carriers.
However, AI tools are only as effective as the knowledge underlying them. To that end, Copilot is trained on more than $21B in dental revenue for faster, more accurate claims. “We apply years of collective knowledge built up from eAssist specialists in getting claims paid,” says Orgill. “Our specialists are well versed in the intricate rules of how Cigna, Delta Dental, Aetna, and other carriers’ claims are paid. We combine this knowledge with the latest Practice Booster data. In this way, we’re able to bridge the gap between the varying claims requirements.”
How Copilot works
Each of eAssist’s 2,000+ billing specialists has access to Copilot when submitting a practice’s claims, empowering them to submit claims faster. When a claim hits Copilot, AI identifies procedure codes, making recommendations on what to include for the claim to be submitted cleanly. This process results in more accurate claims and faster claim submissions. Data shows that claims submitted using eAssist Copilot are paid 41% faster than those submitted outside the Copilot AI and billing specialist process.
Integrating human expertise
eAssist does not rely on AI tools alone. Billing specialists are always part of the process of ensuring a smooth submission. Because of this, Copilot comes with a built-in override button. Specialists review each potential claim before it’s submitted, check the AI recommendations, and have the option to override them as needed.
“We track those overrides to continue to improve the software engine,” says Orgill. “Blending AI with human expertise is the best of both worlds. This way, our clients benefit from the latest AI technologies along with the aggregate knowledge of our billing specialists. We’ve added AI to help our specialists do their jobs more effectively.”
He adds, “That also means responsibly leveraging AI. It’s not the tool for every job, and it doesn’t stand alone to replace humans for crucial tasks like this.”
eAssist’s philosophy around AI
Orgill is quick to point out that you can’t simply throw claims to the wind and expect AI to do the job. AI needs the billing specialists’ expertise to shine. Each specialist comes to eAssist with at least three years of dental billing experience and must pass rigorous tests as part of their vetting process. These highly sought-after experts make the difference between a claim that sails through and one that’s denied.
Applied correctly, AI frees eAssist’s billing specialists to spend more time on meaningful work instead of rote tasks. The goal is to give them the capacity to fulfill higher-value tasks and support more practices.
Achieving high-quality assurance standards
When deploying a HIPAA-compliant AI tool for billing specialists, there’s no room for error. “The way we employ AI is very accuracy-driven,” Orgill explains. “We need a very high degree of confidence in AI’s suggestions before it’s embraced by our specialists. That’s part of their DNA. They are in full alignment to bring in as much money for our dental practice clients as possible, so they have a low tolerance for inaccuracy.”
Coupling AI with human knowledge
Through data-driven insights and years of testing, eAssist found the sweet spot where AI and human expertise work best together. “Finding the right balance is key,” explains Orgill. “When combining AI with human interactions, there’s a certain profile of things that the human knows. Where the human has a gap is where you can potentially add AI.”
eAssist’s goal is to represent that collective knowledge. “The caveat is that we still have overrides. Because AI still has room for improvement, as the tools evolve, we continue to have double checks to ensure that accuracy and expertise are embedded into each claim.”
Having this infrastructure in place, strengthened by CoPilot technology, enables eAssist to reduce payment cycles to improve cash flow and revenues. These operating principles help bring peace of mind to dental practice clients. They can rely on eAssist to not only “put out fires” when it comes to outstanding accounts receivable, but also continue to cost-effectively add value by optimizing collections over the long term. To see how CoPilot and eAssist can strengthen your collections and cash flow, schedule a free consultation today.
