Capabilities

Collections rate improvement, AR aging reduction, denial management, and clean claims rate optimization. Target: AR over 90 days below 15% of total, net collection rate above 98%.

Equipping frontline teams with the communication frameworks and financial presentation skills that move acceptance rates from the 30-40% range toward the 55-60% industry benchmark. For a practice presenting $2M in treatment annually, a 15-point conversion improvement generates $300,000 in additional collections.

Vendor consolidation, formulary compliance, and procurement discipline that reduce supply costs from the industry average of 18-20% of collections toward the 11-13% benchmark — a 5-7 percentage point EBITDA improvement.

Scheduling optimization, clinical support staffing ratios, and production analysis that improve revenue per clinical hour toward the benchmark of $500-700+ for general dentists.

Systematic identification and elimination of cost leakage across labor, facilities, technology, and administrative functions without compromising clinical quality or patient experience.

Operational improvements implemented 12-24 months before a planned DSO transaction or practice sale to maximize recast EBITDA and the valuation multiple applied to it. Unrepresented sellers routinely leave 20-40% of deal value on the table — operational preparation closes that gap.

The seven RCM workstreams that determine how much of the revenue generated clinically flows through to EBITDA: payor AR and denial management, patient AR strategy, payment variance resolution, ERA improvement, payor fee negotiation, patient financing optimization, and call center performance. Across published engagements, Viturtal has identified RCM opportunities of $13.2M at a 30-location DSO and $56.7M at a 100-location platform.

CDT-to-CPT cross-coding for 34 dental procedure codes with demonstrable medical necessity, capturing the 2-3x reimbursement differential between dental and medical payers. At a national DSO scale, Viturtal has identified $99.1M in annual medical billing opportunity from this single workstream.

Reducing average credentialing time from the typical 90-100 days toward the 30-day best practice through delegated credentialing models and vendor SLA management. A 70% reduction in credentialing time generates $1.1M+ in Year 1 revenue recovery at a 30-location DSO.

Enterprise-grade supply chain management including vendor consolidation, formulary governance, GPO leverage, inventory management, and procurement discipline. The supply chain maturity gap between ad hoc purchasing at small scale and optimized enterprise procurement compounds non-linearly — at 20-50 locations it becomes a C-suite issue.

Standardizing clinical protocols, financial reporting, RCM workflows, and operational systems across acquired practices. The 100-day integration plan establishes baseline metrics, implements quick wins, and builds the operating systems that sustain performance improvement over the hold period.

Performance measurement, accountability structures, meeting cadence, and decision frameworks that enable consistent execution across distributed locations without requiring founder or CEO involvement in daily operations. For a detailed comparison of cloud and on-premises practice management systems for DSOs — including total cost of ownership, migration risk, and vendor lock-in considerations — read our cloud vs. on-premises DSO guide.

Benchmarking contracted rates against FairHealth 70th percentile by payer and geography, developing negotiation strategy for the highest-volume code-payer combinations, and embedding annual escalator language in renegotiated agreements.

Transforming call centers from cost centers into patient relationship and revenue capture functions. Treatment plan acceptance rates in DSO call centers average 10-20% against a 50-60% industry benchmark — closing that gap through scheduling of accepted but unscheduled treatment, financial arrangement facilitation, and extended coverage.

Assessing the seven operational categories that financial diligence consistently misses: revenue cycle, credentialing, supply chain, workforce, technology, compliance, and patient experience. Quantifying each gap in dollar terms and building operational assumptions into the value creation model before close.

Establishing baseline metrics, implementing quick wins in supply chain, credentialing, and RCM, and building the operating systems that sustain performance improvement over the hold period. The 100-day plan is designed to demonstrate momentum while building the infrastructure for long-term value creation.

Quantified opportunity assessment and implementation roadmap presented at the board level, with pro forma P&L projections, KPI architecture with leading and lagging indicators, structured risk framework, and phased implementation roadmap. Viturtal has developed board-level dental platform strategies identifying opportunities of $263M in annual improvement at the national DSO scale.

Operating system implementation, leadership team development, and performance monitoring infrastructure that sustains improvement and compounds value over the full hold period.

For a foundational understanding of the five EBITDA levers in a dental office, read our EBITDA driver analysis.

Identifying and capturing remaining operational opportunity in the 12-18 months before a planned exit to maximize valuation and EBITDA trajectory for buyer underwriting.