90% of Patient Ledgers Are Wrong - Here's Why.

What if the number on your AR report is giving you false comfort and your patient ledgers are quietly wrong? We dig into a hard truth from dental billing and revenue cycle management: most practices have never audited their ledgers line by line, which means balances, credits, adjustments, and write-offs can be fundamentally inaccurate. That is not just a money problem. It is a patient trust problem, and it can become a compliance problem fast.

We get practical about reading dental practice reports the right way, starting with the biggest mistake we see: lumping patient AR and insurance AR into one number. Those buckets behave differently, follow different rules, and demand different follow-up. We also talk about aging, why over-90-day AR often has low collectability, and why an AR cleanup project should be treated as a cleanup project so you can get clean reports and real visibility.

Then we break down the biller levels that determine whether your practice protects revenue or leaks it: A players, B players, and C players. A player billers dissect the EOB, compare it to the breakdown of benefits, challenge underpayments and denials, and understand key rules like prompt pay law and the right to recovery. We also shine a light on the most neglected report in dentistry, the credit balance report, and why patient credits can turn into unclaimed property obligations depending on your state.

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Transcript

Patient AR Versus Insurance AR

Credit Balances And Compliance Risk

What An A Player Biller Does

B Players And C Players Explained

SPEAKER_00 1:25

Let me ask you a question. What if I told you that over 90% of patient accounts are inaccurate? Not slightly off, not just a small balance here and there. I'm talking about ledgers that are fundamentally wrong. Balances that should not exist, credits that were never caught. Adjustments posted incorrectly, patients paying for things that they don't actually owe. Now, before you immediately think to yourself, that's not my office. How do you know? Have you actually audited your patient ledgers? And I don't mean just a quick glance, I mean line by line. Because I can tell you this with confidence. Most offices have never done that. And that means there's a very real chance that your practice is one of them. And if that makes you feel a little uncomfortable, good. Because this is not just about the numbers. This is about patient trust. It's about compliance. It's about revenue quietly slipping through the cracks every single day. So today we're going to talk about why this is happening. And it comes down to one thing: biller levels. I call them A players, B players, and C players. And once you understand the difference, you're going to look at your billing department very differently. But before we even get into biller levels, I need to talk to you about something I see all the time and a very common conversation I have with dentists: reports. Most dentists do not understand how to read their reports accurately. And that is something, and that creates a systems problem. Because what happens in most offices is everything gets lumped together. You pull up a report and it shows one big number, and that report is the AR report, and everyone breathes with a sigh of relief or panic based on that one number. But here is the problem. There is a massive difference between patient AR and insurance AR. And if you do not know how to separate the two, you are making decisions based on bad information. Patient AR is money owed by the patients. Insurance is money owed. Insurance AR is money owed by insurance. And those are two completely different buckets because they behave differently, they require different strategies, and they're governed by different rules. But most offices look at them as one. Because you might think we have 200,000 in AR. Okay, but let's break that down a little bit. How much of it is actually collectable from insurance? How much of that is sitting in aging over 90 days? Because you guys know if it's over 90 days, it's like less than 10% chance that you're going to actually collect that money. And side note, AR cleanup projects are not collection missions, they are projects. It is what it is. It's a cleanup project so that you have clean reports. I hear a lot of dentists who will say, you know, I've got 300,000 sitting in AR and they want to pay a company a percentage of what is collected of the 300,000. That's not fair to the third party because there is so much work that goes into tracing claims and following up with patients, and most of that money is not collectible. Or better yet, a lot of those old claims have already been paid. But the effort and the time invested in tracing and going beyond just checking the insurance portal to make sure that a claim has actually been received is so time consuming. So when you are doing, when you're working with a third party to do AR cleanup, know that this is not going to be a collections mission. It never has been, never will be. How much of that is patient balances that are never going to get paid? And here's another piece that almost no one is paying attention to: the credit balance report. Patient credits. That report is one of the most neglected reports in dentistry. And it should not be because there are laws around that money. You can't just keep credit sitting on a patient's account indefinitely. If a patient has a credit and it goes beyond a certain time frame, that money has to be returned or used. And if you can't locate the patient, that money does not belong to the practice. It becomes unclaimed property. And depending on your state, you are required to turn that over. So let that sink in for a bit. How many offices are sitting on credits right now, not even realizing they're out of compliance? This is why understanding your reports matters because billing is not just about getting paid. It's about handling money correctly. It's about compliance, it's about accountability. And most offices, most billers in offices are not trained to see it that way. Now, let's bring this back to biller levels. Because the reason all of this is happening comes down to who is managing your billing. Let's start with my favorite: the A-Billers, the A players. These are the unicorns, friends. These are what I call the rainmakers. An A-Biller is not just submitting claims, they are driving revenue. They understand that billing is not a task, it's a system, and it has a ton of strategy involved. They don't just read EOBs, they challenge them, they analyze them, they validate them, and they know when something is off. They know when an insurance company is underpaying, when something was bundled incorrectly. They know when a denial is legit versus when it's just a delay tactic. And here is what separates them even further. A billers understand state and federal laws. They know prompt pay law. They understand timelines. They know when interest may be owed to your practice. They understand how the high tech act comes into play. And they don't just know these things, they apply them. They review they use them when they are reviewing EOBs. They use them when they are appealing claims, they use them to hold insurance companies accountable. That is that is a completely different level of billing. An A biller is not intimidated by an EOB. They dissect it, they connect it back to the claim, the documentation, and the contract. They ask, was this process correctly? Was this downgraded, downgraded appropriately? Is this denial legit? And they don't just stop until and they do not stop until they get their answers. A players are proactive. They're looking at charts, they're looking at clinical documentation, they're looking at attachments before the claim is ever submitted. And they could be saying things like, This is going to get denied because this x-ray is not sufficient. We need to fix this before I submit the claim. That is a rainmaker, my friends, because they don't just collect money, they recover it and they protect it. Side note as a billing company owner, I read EOBs for fun, believe it or not. And this is why I say I'm a dental billing geek. I review EOBs all the time on the weekends, downtime. I go and I look at the EOBs that our offices are uploading and I search for errors. And let me tell you, I catch them all the time. The math, a lot of times, is not mathing. And or they're not paying the percentage that they gave us when we initially got our breakdown of benefits. I compare the EOB. So they pay for a crown as an example. They paid it at 50%. But when I go look at the breakdown of benefits, I see that that crown should have been paid under BASIC. And this is where, again, we lose money because we don't dissect that EOB. Every biller on my team knows how to dissect an EOB and challenge those inaccuracies applying state and federal laws. So, with that being said, let's now talk about our B players. These are your solid billers. They are dependable, they do their job, they submit claims correctly, they follow the process, they do not need constant supervision. If you give them direction, they will execute. But here is the difference. They stay in their lane, they are not digging deeper, they are not expanding beyond what they were taught, and they are not necessarily questioning the system. They're using basic standard codes and they're following standard workflows if there are workflows in place. They get the job done, but they're not elevating the revenue cycle. They're not aggressively identifying missed opportunities, and they're not pushing back on insurance behavior. And again, there is nothing wrong with a B biller, but because every business needs the B players too. But you need to understand what they are not. They are not your strategist, they are not your problem solver, and they are not going to fix a broken system. So that is the difference between an A player and a B player. Now let's talk about the C billers. And this is where things really start to break down. C billers are what I call glorified front office people, glorified front office individuals. They were taught the basics of billing. They know how to submit a claim, they know how to post a payment, but they do not understand billing on a deeper level. They trust the EOB blindly. They say things like the payment matched the EOB, as if that means the EOB is always accurate. Because let me be very clear, the EOB is not always accurate. I told you, I read EOBs for fun, and I can tell you most of the time I find an error in most of these EOBs that I read. The C billers do not audit accounts after posting an insurance payment. They do not reconcile balances, they don't question adjustments, and they do not review the ledger as a whole. They're just checking boxes off. They're not actually thinking critically.

SPEAKER_01 15:06

And here's where the danger and here's the dangerous part.

Should Billing Be In House

Free Strategy Call Invitation

SPEAKER_00 15:16

They believe that they are doing a good job because the system looks like it's moving. Claims are going out, payments are coming in, but underneath that, everything is off. And friends, you guys, if any of you have ever been to my workshops, you know that I always say this: just because your claim was paid does not mean it was billed correctly. The idea behind billing is to submit clean, valid claims so that in the future you don't run the risk of having to give the money back. So, as an example, if a claim is paid and you submitted an x-ray that has a cone cut on it, the insurance company can ask for the money back because that cone cut wasn't supposed to be there. X-rays are so important to be so spot on because insurance companies look for every reason to recover money. It's called the right to recovery. And if you don't know to question stuff like that, then you're not an A player, right? So your balances are wrong, credits are wrong, write-offs are wrong, and no one is catching it. And here is where I'm going to say something that might upset people. Most billers in dentistry are C players, not some, most. And I'm not saying that to be controversial because I'm not trying to be controversial. I'm saying that based on real experience. I recently put out a call that I needed to hire 30 billers. I was flooded with applicants. Over, I think I did like over a hundred interviews. It was like a couple of weeks of just back-to-back interviewing. These are people who currently work in dental offices or for my competition, other billing companies. And if I felt they had potential, I would have them take our entrance exam. And let me tell you, friends, facts not one person passed my entrance exam on the first try. Not one. Some were close, but many had multiple attempts. And by multiple attempts, five, six, seven, up to eight times to pass the exam. And these are people that are currently managing revenue cycles. And the questions they were failing were related to state and federal laws, they were related to EOB language. And these are people that, according to their resume, have 10 years of experience as a biller. And I want to say that just because you've been a biller for 10 years, that does not make you an A player. I want to talk about the patient ledgers. If your billing is being handled by a C player, there's a very high likelihood your patient accounts are inaccurate, which means patients are being overcharged or undercharged or sitting with credits that should have been addressed. And this is where it becomes bigger than billing. This becomes a trust issue because when patients lose trust in your financial process, they hesitate, they question treatment, they delay care. And now your billing problem becomes a production problem. Now let's talk about the big question. Should billing be in-house? Here's the truth. It's not that billing cannot be done in-house. It's that most offices are not equipped to do it well. They don't have structured training. They don't have quality control. They don't have systems of accountability. They don't have ongoing billing education. So what happens then? They hire someone, train them just enough to function, and then leave them alone. And that person becomes a C biller over time. Not because they're incapable. That's not what I'm saying here. I think everybody is capable of becoming an A player. But rather because no one required more from them. No system pushed them to grow. No one audited their work. So the real question is not: should billing be in-house? The real question is: do you have the infrastructure to support high-level billing? Are your reports being reviewed correctly? Are your AR categories separated and analyzed properly? Are your patient credits being managed in compliance with the law? Are your ledgers being audited regularly? Or are you just assuming everything is fine because your claims get paid? Because assumption is where the money gets lost. And if you're a biller listening to this, I want to challenge you, friend. Where do you fall? Are you an A player who is consistently learning, questioning, challenging, and applying? Are you a B player who executes well but stays in your comfort zone? Or are you a C player going through the motions and trusting a system that is flawed? Because in time, because time in the industry as a biller does not equal skill set. Five years of doing something wrong does not make you experienced, it makes you consistent and not in a good way. So here is what I will leave you with, friends. Whether you think you have a billing department or not, you do. Every practice has one, and that department is either protecting your revenue or quietly costing you money every single day. So here is my gift to you as my listener. If you're not sure what is really going on in your billing, I want you to book a billing strategy call with me. It's free and it's my gift to you. There will be no pressure, no fluff. I just want to provide clarity. We will take a look at your billing, identify the gaps, and talk through what needs to be fixed. Because once you see it, you cannot unsee it, my friend. And that is where the real change begins. So if you enjoyed this episode and it hit home for you. If you enjoyed this episode and it hit home, let me know by sending me a message. Let me know if there's anything I can do to serve you well. Until our next episode. Stay diligent, my friends.