On The Road E05 - Dental: Krysten Garduno

Key takeaways: 

Revenue cycle management addresses the payment of a claim, from before the patient comes into a dental office through the time the insurance pays the claim
Medical has been outsourcing billing for 20 years; dentists are now beginning to outsource it…and we’re at the forefront
Phrase to use: “Increasing collections, decreasing A/R”
We only are paid on performance—it’s not tied to hourly work; if our clients don’t make money, we don’t either

Eli Johnson (00:00):

Another episode of on the road. I am here today with Krysten Garduno out of our Denver, Colorado office. We are going to be talking about Avitus Dental billing and all things dentists. Let's go.

Eli Johnson (00:32):

How was your flight in from Denver?

Krysten Garduño (00:34):

Bumpy!

Eli Johnson (00:36):

Bumpy because it was United?

Krysten Garduño (00:38):

Delta. I shouldn't say that out loud. There's a lot of Delta lovers...

Eli Johnson (00:43):

Lotta Delta lover's at Avitus Group. Yes, there are. I thought that was a soft toss there. That's okay. Alright. So first question. We've got appointed consultants listening on the Vensure division side. We've got Avitus Group, business development people, many of which you are very, very familiar with. But, I'm a dentist, and I hear about this thing called revenue cycle management. Break it down for us. What exactly is this?

Krysten Garduño (01:07):

Yeah, sure. So revenue cycle management is just a phrase that really coins the cycle of a claim. Okay. So a claim in dentistry is how doctors get paid. It's insurance companies paying them. So when revenue cycle management comes into play, it's three days ahead of the patient coming in up to sending the claim out with proper coding, down to tracking the insurance AR, patient AR, and really long, you know, long story short is it's how the dentist gets paid.

Eli Johnson (01:38):

Okay. So if I'm a dentist, anywhere in the United States, I'm dealing with this, whether I'm using a company, I'm using Avitus dental services or I have a staff member doing it, or I'm doing it. It's a thing. That's the only way I'm going to get collected.

Krysten Garduño (01:50):

Right. So, it's specifically insurance collection, so they need to be PPO providers, and be in network with some insurance companies, but 95% of dentists nowadays are because that's how you get new patients.

Eli Johnson (02:04):

Gotcha. Okay. So when you look at the landscape of all the services that are under the Expert Service umbrella, we've got Accounting, we've got Avitus Technology, we've got recruiting. The dental one kind of sticks out there as what Lance Harris out of our San Ramon or Sacramento office would say "left footed". That seems left footed. It doesn't seem like it goes with everything else. Right. So tell us how we got into this space, why it's important and why our appointed consultants and our team members need to continue to bring this up with our prospects and dental clients alike.

Krysten Garduño (02:35):

Yeah. I mean, the story is kind of cool actually about how Avitus Group got into dental. Willie actually went to the dentist one day and he had an experience where his claim wasn't getting paid, I believe is what the story is. And then he thought to himself, well, these guys go to school for eight years and they don't have any knowledge on how to do this type of information. And then he identified the need. So Willie had some sort of a personal experience. But at the same time, you know, Chris Balster and I believe Ken Balster had a contact with the CDA, the Colorado Dental Association. And so from those two kinds of ideas, it branched into what's now Avitus Dental and the revenue cycle management program. We...

Eli Johnson (03:22):

And full steam ahead now, right?

Krysten Garduño (03:24):

Yeah, absolutely. So we have...full steam ahead. We were in the dental management solutions area where that was kind of providing consulting services for doctors, realized that there's not much of a need in that space, but the virtual dental billing took off instantly, getting clients. Every doctor needs this service. So, there's not one dentist that you could approach that wouldn't need this service within their practice, whether it be somebody in their practice doing it well, and maybe they want to unload their plate, maybe somebody they don't have in their practice at all.

Eli Johnson (03:59):

That is extremely helpful. Thank you for that. And I think I relate this to some of our other services. The question I'm about to ask in that, as business development reps in the field, we like to have tag lines attached to our service understanding. So for accounting, we like to know that we do accounts payable and accounts receivable. That's enough ammunition sometimes just to get to the next conversation. Dental billing is one where I think a lot of people could be feeling insecure about, or I'm not sure how to have enough confidence to move this forward, but really what are just a few things they need to know, revenue, cycle management, being a tagline, right. What else do they need to just feel real comfortable to share, to get beyond that gatekeeper?

Krysten Garduño (04:38):

So "revenue cycle management" is great. Also some key words are "increasing your collections and decreasing your AR". So it's the same. We have accounts receivable, whether it be outstanding in insurance claims or patient balances. So increasing collections, decreasing AR, submission of claims, insurance verifications, um, those are all big words and, you know, to be a little fluent in dental, that would be helpful. I think another big piece that's really helping some of our business development that's doing well is, you know...medical has been outsourcing their billing for 20 years. So now this is something new that dental is leaning towards. We're always 20 years behind medical. That's just how it is. And so when they're talking to prospects, they're just saying, you know, we would like to kind of propose this new wave of how dental billing is being now outsourced, and it's becoming more and more popular in the dental industry and we're kind of on the cutting edge of it and we're kind of pioneering it.

Eli Johnson (05:38):

Yeah and you were at business development quarterly meetings, not too long ago. And that was something I took away, that what we're doing in the dental space — and what we've only tipped our toe into the water with, but it's just beginning to, I mean, push way forward, way faster than we thought — is a concept that's new to people. It's not something all over the United States they're doing, but we get to pioneer that, and that's exciting. And it does delve well into the other services we do, which we want to be a support and a blessing to our small business clients, whether you're a construction company or a brewery or a dentist. So very, very helpful. Now when it comes to Avitus Dental, one of the questions that we've gotten in the field a lot, when we bring these subjects up around this service is: do you handle all of healthcare? Can you do other things outside of the dentist space? So is Avitus Dental only for dentists? What about orthodontist? What about endodontists or whatever? All the "dontist" names out there. What else are there?

Krysten Garduño (06:36):

Yeah, so we deal with general dentistry and specialty. So anything ending in "dontist" we take care of...orthodontist, endodontist, prosthodontist, periodontist, general dentist, all of it. Um, oral surgeons. We take care of any specialty, anything in the ADA realm, which is the American Dental Association.

Eli Johnson (06:57):

Yeah. But be prepared for us in the audience that are all in the field listening. We just need to remember this is a relatively new concept. So we might be met with a tiny bit of resistance and, "Oh, that sounds strange compared to what I know now, which is what I've always known", but what an opportunity for us, correct? Because whether you're a construction client or anybody that has AR, if you get to increase accounts receivable, that gets everyone excited. Right?

Krysten Garduño (07:20):

Yeah. And you know, what's a really good tagline actually, if I go back? We are paid off of our performance. So our services are paid off a percentage of the collection we bring in for the dentist. So it's not...a lot of dentists across the country are at 50% capacity because of the pandemic. So they are constantly paying a flat rate, direct labor to their people. It doesn't matter how many hours they're doing or...Hourly wages obviously matter, but it doesn't matter if they're sitting there on their phone or if they can be there full time. We are paid off our percentage off of our performance. So the way we like to say it is that our values are fully aligned. And if, if you don't make money, we don't either.

Eli Johnson (08:05):

Yeah. That's awesome. Years ago we had CFO assistance similar to this. And when the companies did well, or the company that we were helping grow did well, we did well. And vice versa. If, if we weren't helping them scale to the rate they wanted, our piece of that was less. I love that concept. Everybody should feel good about that type of relationship. Alright. Time to dig deep. Uh, we do business with people we like, we like people we trust. That takes time. You've got to get to know the Krysten, right? So just from the human element here, what are three to five things you want our audience to absolutely "must know" about Krysten, our team member in Denver that does Avitus Dental.

Krysten Garduño (08:42):

Oh gosh.

Eli Johnson (08:43):

Hidden talents, favorite beverage. It's your time to shine. And you can tell us whatever, whatever you want.

Krysten Garduño (08:50):

Well, um, I am a very good rapper. I'm a very good rapper. Business development did get to witness...

Eli Johnson (08:56):

That's a fact! That is fact. You and Kendra Hatch could team up and just spit some serious rhymes.

Krysten Garduño (09:01):

Yeah. Yeah, no, I'm not a great rapper. That was just fun. And so one thing that...I do coach two sports. I coach fast pitch softball and competitive volleyball in Colorado, which is super fun. Um, I've lived in California and Hawaii and Wyoming. And so that's pretty cool. I like coffee at all times of the day. I run on afternoon coffee, morning coffee. Doesn't matter. I'm very sarcastic, hopefully only in the good times. But, if I'm ever saying something that you're like, "I don't know if she's joking." I'm joking. And I don't know, I think that's five?

Eli Johnson (09:40):

Yeah. That's good. Volleyball, softball, Wyoming, and Hawaii. I've got some things to remember. Krysten by. Thank you. Final two questions. And I'm gonna let you drive it home here in just a minute with the last one, but we've got some pretty darn exciting news. That's happened very recently in the Avitus Dental space with a new partnership. Tell us about the Cosentus partnership, the team, the structure, why that is such a monumental win for our company and to our clients.

Krysten Garduño (10:07):

Yes. Yes. So huge, huge win, huge partnership that we have officially got completed on July 1st. So Cosentus is an offshoring company based out of new Delhi, India, and they also have some onshore resources in California. We've partnered with them and the way that we're going to be able to service our clients is going to be insane. So we're going to be able to take on the big clients and scale. So instead of getting a new client and me scrambling, trying to find out who I'm going to assign this to and how we're going to do a great job. Well, we have a bench of people over in India that are being trained every single day, and that are just waiting for us to assign them accounts. The way our structures have changed is: in the past, sometimes we just don't get to insurance AR or something like that.

Krysten Garduño (11:00):

It's pushed on the back burner. But, with the Cosentus partnership, we have somebody specializing in claims, somebody specializing in insurance AR, somebody specializing posting payments. So all of the services that the doctors sign up for get worked every single day, but managed by an onshore account manager that has 10 to 25 years of experience. That's the experience on my team right now. So they only work with the account manager. There's one point of contact, but she's got a team below her. She's got a team doing a lot of things. So that allows us internally to have not five clients, but 15 clients. You know, before, we would have to be overloaded and move on to someone else with filling up their plate.

Eli Johnson (11:47):

Yeah. Well, what I...that is super exciting. We got to meet the owner of Cosentus recently, what a phenomenal entrepreneur. And so this partnership is such a perfect collision, no different than the Avitus group and Vensure partnership is. But what I like and what's happened in the Avitus Dental space with that Cosentus partnership is similar to what we've done in the PEO world, where for years and years and years, we've had the concept presented to companies and they love it. "Of course I'd want to engage in the co employer relationship", b–ut not always the software—from our standpoint—that delivers to the same experience that the overall service concept does, right? Now, we move over to Vensure and we've got access to V-fficient. We've got access to Prism HR, which are the same thing. Better options by way of technology. Oh my gosh.

Eli Johnson (12:35):

It just makes these conversations we've had in the past be able to come back to the surface and start again because companies that we couldn't engage with because they couldn't see the technology advantages or disadvantages. They couldn't see beyond that. Now we get to go back and say, "now we've got everything", right? I think it's the same in the dental space. I think that you have the opportunity now that Dan Bowers, the appointed consultants, that people on our team that are going to present this, they can have such confidence in the deliverable to the client. And I think when you're in a sales role and you get to do that, things get really exciting. We are on the cutting edge and the cusp of some very, very exciting things. So ACs and BDs, let's go crush it because Krysten is doing a great job in the Avitus Dental space. And we are excited to have you as a team member. Because this is such a unique service to leave our team with a three to five final things you want to know about dental, because that's probably what they're going to recall after this On the Road episode.

Krysten Garduño (13:32):

Okay. Three to five things we should know.... Ideal clients for us: 2 to 20 providers. We can take on, as our BDS like to call it, we can take the whales, now. We have the scalability and we want to stay away, necessarily, from the smaller dental practices because the insurance revenue needs to be a little bit higher for us. And we can scale with that. So the ideal client: 2 to 20 dental providers. The second thing is: everybody needs us. There's there's not a dental practice in the U.S. that doesn't need this service. Third thing is: call me anytime you have questions. Anytime day or night, weekends, doesn't matter. I'm very available for business development and ACs. I wanna make sure that, you know, their growth, their success is our growth and our success. So I want to make sure that that's really clear and always give me a call and just jump in, just jump in. Some people think, "Oh, I'm, I'm uncomfortable with dental." "I don't know what to say." Well, throw a couple of words their way that we talked about earlier—"insurance AR". Get me on the phone and you'll learn as you go. Reach out to, you know—some of the BDS on the Avitus side are very strong with the dental reach out to them. Right. They have some great, great kind tag lines or by

Eli Johnson (14:52):

Yeah, 2 to 20 providers. What does that mean?

Krysten Garduño (14:55):

20, dentists or hygienists.

Eli Johnson (14:57):

Okay. So that could be a smaller practice or a pretty darn big practice practice. But I think the takeaway that you just left our audience with is what I want to drive home. Just jump in. It's like any of our expert services, we've grown these over the years. We used to only have accounting. Then we added Avitus Technology. Then we added marketing. Each time you add that service, you think, "well, I don't know anything about that." You get one at bat, you get one opportunity with a prospect that becomes a client and it all becomes clear afterwards. All right. It has been so fun having you. Thank you so much for being here. I love doing this and I love getting to know more about Avitus Dental. This has been very helpful for me. Final thing to leave our listeners with...case study, recent win, something you want them to understand with full context of a scenario, let them have it.

Krysten Garduño (15:44):

Yeah, well, we've had a lot of, a lot of great wins lately. I would say one of the biggest things is that our last five signs, the average annual revenue has been $85,000. We think that's gonna be the average. So I'm coming out of this pandemic where we are doing some numbers, searching and whatnot, but that ranges from a big client from $180,000 annual revenue down to one of the smaller clients. And I'm doing quotations that you can't see, but the smaller client was, you know, $25,000 in revenue and in dental, we think that's going to be on the smaller end. To my understanding, for other other departments that's not necessarily on the smaller end. But yeah, our average is around $85,000 in annual revenue. I think another great point is that a couple of big signs that have come through? Um, I can say names, right? Yeah. Yeah. I can say names here. Um, Kody Boles, he

Eli Johnson (16:44):

Kody Boles, Kansas City, shout out, go Chiefs.

Krysten Garduño (16:47):

Go Broncos. Just kidding, Kody. Um, no, but he pursued them. I know he's so mad. We do this all the time. Um, so he pursued them back in January and February. Two of his big clients, one was around $68,000, one was $180,000 in annual revenue. He pursued them back in January, just signed them in June. And that's one because he was comparing us. One of the offices comparing us to hiring an office manager instead of us. Well, they came back because she quit. So now, with turnover high in dental they're coming back to us. They don't want to deal with it anymore. That's the $180,000 annual revenue one. And the other one was simply because he's scaling into a second practice. So maybe it's not instant signs, but they've been coming back. A couple of Tristate area ones have been coming back. They're out there. The commissions are high and we're able to deliver now. So...

Eli Johnson (17:45):

I love that. And just for everyone's understanding around that $85,000 average number, that is enormous. That is unlike anything else we experience. We have great averages across all of our Expert Services, but accounting would probably be 12 to $15,000. Annually marketing would be 24 to $30,000. We like to start clients at $2,000 a month and then go up from there. Recruiting can be, you know, up and down, but, you know, everybody that's listening sells PEO. A lot of PEO clients are $15,000 in revenue, plus the premium in work comp profit. That is a lot of PEO clients. That is a lot of accounting clients that you've gotten with one dental billing service client at 85,000 bucks. So good on you, Kody Boles. Getting a shout out today, but we will need business. We will need clients next year. So all the seed planting we do, all the conversations we're having right now...like you said, it might be a longer term play, or it might be a perfect collision where we meet them, right? When they have a significant need, everything is changing out of this COVID environment. And I love that you're pioneering a service that is on the cutting edge. So great job, Krysten. So fun having you, enjoy your time here in Montana. July in Montana, it doesn't get better. This is an episode of On the Road. Thank you.