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No matter how long you’ve been in the dental billing game, there’s always that nagging feeling – am I missing something? Did I do that right?
This webinar is about learning the essential habits that keep claims moving, cash flowing, and your front office team from feeling buried. We cover the four building blocks of dental billing and go over practical steps dental teams can start putting into practice today.
This isn’t about memorizing codes or becoming a full-time biller. It’s about learning the essential habits that keep claims moving, cash flowing, and your front desk from feeling buried.
The goal isn’t to add more work — it’s to reduce rework, eliminate blind spots, and make billing feel more manageable for your front desk and your practice.
Watch the recording now to start turning strong care into stronger claims.
Want to dive deeper? The ABCs of Dental Billing for even more tips, examples, and tools.
Q&A
What do you tell people when the front office is bought into outsourcing, but the doctor is skeptical and thinks it’s just about saving time?
Tell the doctor this is not a time saving play, it is an ROI play. The proof is in collections and cash flow, not opinions. The best path is a trial for 3 to 6 months and compare insurance collections and what shows up in QuickBooks month over month. We also do not believe in long term contracts because it has to be a win win for the practice. If the ROI is not there, you should not keep doing it.
Do we calculate refunds back in our collections?
Yes. If you are calculating collections correctly, refunds reduce collections because it is money leaving the practice. The simplest clean approach is total collections minus refunds for the period. Then divide by net production for the same period. Net production should already be after adjustments and write offs.
How do you handle denials for claims with a denial reason that doesn't make sense? What are the escalation steps for this issue?
First, appeal every time. Payers pay attention to offices that appeal and offices that do not. Second, ask for a peer to peer so your dentist can speak to their reviewing dentist and confirm what documentation they say is missing. Third, call and request the highest level supervisor and be kindly firm. Fourth, document everything in claim status notes every call, including rep name, reference number, and exactly what was said. Fifth, ask for the reviewing dentist’s credentials and license information if you are being stonewalled. Sixth, once you have exhausted the internal routes, involve the patient and if needed their HR. One call from the member can sometimes move it faster than ten calls from the office.
How does calculation for collections work with our in house membership plans?
Run the same collections formula, but keep your membership discounts from distorting your numbers. The cleanest way is to use a specific adjustment type for membership plan discounts and exclude that adjustment category from the net production you use in the collections calculation. That way you are not penalizing the practice for “production” you never intended to collect at full fee. You still want to see a healthy collection percentage on the amounts you actually expect to collect.
How do you keep the office up to date with appeals?
Make it a monthly rhythm. Every month review, with the doctor and ideally the team, the insurance aging, patient aging, collection percentage, and adjustments. For appeals specifically, use the 30 plus insurance aging report and include claim status notes so you can see when each claim was last touched and what has been done. Then go claim by claim and review current status and next step. Also build a weekly workflow where you post payments early in the week, then batch denials and appeals later in the week, and pull in the doctor when you need better notes, better attachments, or clarification. Appeals are a team sport because documentation, x-rays, and photos come from the clinical side.
How do you overcome the MetLife constant denials for core buildups?
Treat it like a documentation problem until proven otherwise. Add a specific buildup template to your clinical notes that prompts the team to document that over 50 percent, and sometimes 60 percent, of natural tooth structure was removed and the buildup is required to restore the crown. Then attach intraoral photos, before, during prep after decay removal, and after. The “during” photo is the money shot that proves tooth structure loss. Include strong clinical notes and the right radiographs. If you are in network, do not accept a straight write off on a buildup denial. Appeal it, at minimum, to shift it to patient responsibility if the plan allows, and ideally to get it paid correctly.
How can you handle an office that is currently out of network but was in network before, keeping same fees for old patients and new fees out of network?
You must submit the fee you actually intend to collect from that specific patient on the claim. If you are honoring an older in network style fee for legacy patients, the claim should go out with that legacy fee, not the new higher fee with a write off later. Only bill what you are expecting to collect. Operationally, keep this as a short transition period because it can get messy fast. Then communicate clearly why you chose out of network so patients understand the value, more time, materials, labs, and not letting insurance dictate care.
How do we appeal when insurance is denied for the crown because it’s not necessary?
Assume the payer thinks you did not prove necessity. First, tighten clinical notes and attachments before the crown is done, because you have to show the condition before. Use a checklist for crowns so nothing leaves without the essentials: strong narrative that is not generic, high quality PA and bitewings, intraoral photos before, during, and after, and any supporting documentation that makes the need obvious. Mark up images if needed with circles or arrows to point out decay, fracture, missing structure, or failing restoration. Then appeal. Offices that consistently appeal get different treatment than offices that do not.
How do we appeal with MetLife denies D7311 when we perform that procedure with the extraction?
Use the same escalation and documentation rules. Make sure the clinical narrative explicitly ties D7311 to the extraction and clearly states medical necessity, what was done, why it was required, and include any supporting images or documentation that strengthens the story. If denied, appeal, request peer to peer, push to highest level supervisor, and document every touch in claim status notes with reference numbers. If still stuck, involve the patient and HR.
Does a divorce decree would take precedence over the birthday rule as for who is primary vs secondary?
Often, yes. Many coordination of benefits rules treat a court order as overriding the birthday rule for a dependent, but the exact answer depends on the plan documents for both carriers and the wording of the decree. The best action is to call both carriers and ask them to confirm in writing which parent is primary based on the decree and their COB rules. Document the rep name and reference number in claim status notes.
Do you need to honor the fee schedule for 1 year after going out of network?
No. In most cases, once you are officially out of network, you are not legally required to continue honoring in network fee schedules. When the termination date hits, you can move straight to your new out of network fees.
From a practical standpoint, it is often much easier to draw a clean line. Use the year leading up to your network exit to clearly communicate with patients why you are leaving the network, then fully transition to new fees at the effective change. Trying to maintain old fee schedules for a year after going out of network usually creates confusion, posting issues, estimate inaccuracies, and unnecessary administrative burden.
The key is confirming your official termination date and any notice requirements in your contract. Once that date passes, you should be billing your true out of network fees and collecting accordingly.
How can we collect amount from patients if they get payments to them?
Confirm during verification whether the plan pays the provider or pays the patient. If it pays the patient, collect in full at time of service and set the expectation before the appointment that the patient will be reimbursed by their insurance. Do not rely on “pay us when you get the check” because it rarely works. After you submit the claim, close it with a zero payment and note “paid to patient.” Tell the patient if they do not receive reimbursement within 30 days to call the office and you will help investigate.