Built to Get Paid Series - Part 5 of 6 - The 3 Metrics That Never Lie

Your insurance AR report is trying to tell you the truth, but most of us only glance at the total and walk away with more anxiety than clarity. I’m Erica Aguilar, and I’m breaking down how to read the story behind the numbers so you can tell, with real confidence, whether your dental billing department is performing well or quietly leaking time and money.

We start with the biggest mindset shift: dollars alone don’t equal performance. I’ll show you how to turn each insurance AR aging bucket into a percentage so you can compare month over month and spot patterns that individual claims can’t reveal. You’ll get clear dental billing KPIs and benchmarks, including what “healthy” looks like when 92% of your insurance money is paid within 30 days, and why a heavy 90+ day category should trigger curiosity, not panic. From there, we talk through the questions that uncover root causes like late claims, missing attachments, delayed clinical documentation, weak claim construction, and payers that keep pushing you past state prompt pay laws.

We also widen the lens beyond insurance AR. I explain why patient AR tells a different story, why the credit balance report can expose compliance issues and unclaimed property risk, how to trend denials by payer and CDT code, and how poor fee schedule maintenance can inflate write-offs and create bad patient balances. Then we get practical with the claims correction list, the simple tool that creates visibility where most practices have none.

If you want a concrete next step, I give you homework to pull your key reports, start tracking denial reasons, and implement the free claims correction list from the show notes. Subscribe, share this with your office manager or biller, and leave a review with one question you want your reports to answer next.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

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Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

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Schedule a billing chat with Ericka:

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Email Ericka:
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Email Jen:

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Transcript

Welcome And The Big Question

SPEAKER_00 0:46

Hello, friends. Welcome back to another episode of the Dental Billing Podcast. I am your host, Erica Aguilar, and thank you so much to those of you that are returning loyal listeners. You know who you are, I know who you are, and I'm so grateful for you. For those of you that are new here, stick around. You might learn a few billing tips here and there. That's what we tend to talk about around this neck of the woods is dental billing, dental billing tips. Sometimes we throw life in the middle of it because life is lifing, right? Today I want to start this episode with a question. I want you to actually sit with it for a second before you answer. Because when was the last time you looked at your insurance AR report and knew with real confidence that your billing department was performing well? I don't mean whether there was money owed to the practice or whether production happened to be up this month, or whether collections just felt like it was a little better than last month. I mean, did you truly understand what those numbers were trying to tell you? Here is what I run into when I sit down with most practice owners. If I ask you right now to look at your reports and tell me which insurance company is consistently blowing past your state's prompt paylaw or whether your write-offs are reasonable versus handing thousands of dollars away because nobody's maintaining your fee schedules. You guys, I see that a lot. Fee schedule maintenance needs to be a part of your drumbeat within your billing department. And I see fee schedules get overlooked, fee schedule management overlooked all the time. So we'll talk about that a little bit later. Or whether your denials are coming from a payer's behavior, was it weak documentation? Would do we have sloppy claim construction? I call that packaging the claim. Or is this just a workflow that is creating bottlenecks that you can't see? And most of you wouldn't be able to tell me where the bottlenecks are, right? It's not because you aren't capable of identifying it. And it's absolutely not because you don't care. It's because nobody ever taught you as the owner that your reports are telling stories. Most of us open the insurance AR report and glance at the total dollar amount sitting at the very bottom of the report. Then you close the report right up and you walk away genuinely believing that you just reviewed your billing department performance when all you actually did was look at a balance. That balance will happily tell you how much money is outstanding, but it will not tell you why it's outstanding or whether it's healthy, or if it's getting better, or if it's quickly pointing to a much bigger problem living somewhere inside your practice. And that, friends, is what the whole episode is about because I want to teach you how to read the story behind the numbers. That's the purpose of this episode. And I promise you, once you can actually read what your reports are saying, something starts to happen because all of that low grade uncertainty you've been carrying around begins to lift. And the questions that have been nagging you for months, sometimes for years, finally

Why Balances Mislead Owners

SPEAKER_00 4:41

start to have answers. Answers that you get because you understand your reports, and you no longer have to rely on one person, your office manager, your biller. It's not that they don't want to give you that information, but as the owner, you need to know how to pull this information and dissect it yourself. So that's what I want to talk about in today's episode. And this could also be for office managers, this could be for the billers as well. We should all know how to answer all of those questions, right? I want to give you the pass to recognizing if a particular insurance company is dragging its feet consistently, like a common offender of slow paying claims, right? You should be able to watch the trend because when you start to learn how to pick up on these patterns, it becomes obvious. And rather than crossing your fingers that your systems are improving, you get to watch the data show you. So month after month, whether the trajectory is actually moving in the right direction. That kind of clarity changes how you lead. It changes the conversations you have in your monthly billing meetings. It changes the way you coach your team, and it changes the confidence you bring to every decision you make inside of your billing department because you stop reacting to random, isolated events, and you start recognizing patterns. And if you've been with me since the beginning of this series, you've probably noticed that I lean on that word a lot, patterns. And that's completely on purpose because patterns are the thing that tell you the story. One denial on its own can be a total one-off. And one aging balance might just be a carrier working through its normal processing time. So individual transactions can lie all day long. Patterns, though, are almost never an accident. They reveal habits, they reveal the way your workflow actually functions when you're not looking. And they point straight at where your training opportunities and your leadership opportunities are hiding. So if you want to understand the real health of your billing department, don't go chasing one claim at a time. I've seen that happen where we look at our insurance AR and we immediately go to that large outstanding ortho balance and then go question the biller about why our insurance AR is so high. Why do we have large balances? Why are these claims not paid? That, my friends, is not the way to look at your insurance AR. We want to look at our insurance AR in terms of performance percentages. And if you are a general practice that does high volume ortho, we've got to figure out how to separate that ortho aging, those orthoaging balances, removing those and truly looking at the general claims that should be getting paid within 45 to 60 days, depending on your state's prompt pay laws. Looking at recurring patterns is what is going to lead you right back to the root cause, right? Because when you find the patterns, when you can see the patterns, you can then start to ask better questions and identify the root cause. That's exactly why one of the very first reports I asked to see when I start working with a new client is their insurance AR. It's not because I care about

Patterns Beat One-Off Claims

SPEAKER_00 8:41

the dollars owed to the practice, it's because I care about the performance percentages. And that distinction matters more than almost anything else I'm gonna say today in this episode. I've watched offices throw a party because their insurance AR dropped $20,000 when their 90 plus day percentage actually got worse. And I've watched other practices panic because their AR climbed after a season of fast growth when the reality was their percentages were beautiful and reimbursement was moving exact at the pace it should, but they were panicking. Dollars on their own, friends, rarely tell you the whole story, but percentages give you the context that the dollars alone are never going to tell. So at Fortune, we hold insurance AR up against real performance benchmarks. And I think you should do the same. Here is what healthy looks like in your billing department. Your zero to 30 day category should be carrying at at least 92% of all insurance money owed to the practice. And what this means is that 92% of the money owed to the practice is getting paid to the practice within 30 days. That's the healthy benchmark. Your 61 to 90 day category should stay below 5%, and your 90 plus day category should stay below 3% of all insurance money owed to the practice. And here's how you actually see this for yourself because it's a lot simpler than it sounds. Instead of reading the dollars in each column, you take each aging bucket and turn it into a percentage of your total insurance AR. And that one little move turns a balance into a benchmark and tells you in about 10 seconds whether your reimbursement is flowing or whether something is stalling it. Now, let's say that you do that and your 90 plus day category is sitting at 22%. I just mentioned that it shouldn't be heavier than 3% of all insurance money owed to the practice. The move there is definitely not to panic. It's actually to get curious because curiosity is a far better leadership strategy than assumption will ever be. And I see a lot of office managers, dentists, practice owners assume a lot of things when they look at AR that has gone a little upside

Turn Aging Buckets Into Percentages

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down. Curiosity is going to be the strategy that we're going to use here. So instead of throwing up your hands and asking, why is AR so high? You start asking what pattern created this in the first place? Are claims going out late? Are attachments consistently missing? Are your providers finishing their documentation days after the treatment actually happened? Is one specific carrier repeatedly paying you outside of prompt pay requirements? Are your appeals actually being submitted well? Or unreasonable denials just quietly stacking up because nobody on the team knows how to fight them. And when you want the answer to that carrier question specifically, group your insurance AR by payer because the company that's parked in your 90 plus column month after month is the one dragging you past your state's prompt pay law. And once you can actually see that, you get to make real business decisions about how many of your patients are tied to that plan and whether the headache is even worth it. In other words, if Cigna is consistently dragging your claims into the 90 plus day category because they are slow payers, this plan is a slow paying plan. Why would you not want to take a look at how many patients you have attached to that plan and whether or not it's worth it to stay in network, right? And notice what just happened, because this is the whole point. The report didn't hand you the answer. What it did was point you toward much better questions. And better questions are what produce better solutions, right? Almost every single time. And the same way of thinking applies to every other report sitting in your billing department because your patient AR is telling you a completely different story than your insurance AR. And you have to run them separately, or you'll never hear either one clearly. With patient AR, you're spot checking for accuracy and you're asking whether the patient truly owes this balance at all, whether the copay actually got collected on the date of service. Did it get calculated correctly in the first place? Are your fee schedules current? Patient AR isn't measuring how fast your biller works, friends. It's measuring whether the money got handled correctly up at the front and whether your statements are actually going out on a regular schedule. Then there's the credit balance report, which is one of the very first things I look at after insurance AR, because aging credits expose blind spots that most practices never even think about. The first thing I do is sort that report by the age of the credit, because the age is what tells me whether I'm looking at a quick little cleanup or an

Benchmarks For Healthy Insurance AR

SPEAKER_00 15:00

entire training problem that's been compounding for years. And those old credits can point to miss postpost payments, outdated fee schedules, insurance overpayments that need to be resolved or unclaimed property obligations you may not even realize you're carrying. And I need you to hear me loud and clear on this, friends, because those aren't just accounting issues. These are compliance issues. From there, we move into your denials. And I want you looking at the trends rather than the raw total. The trend tells you the story, right? I want you to be able to go read these reports like you're reading a story. So which insurance companies are denying you again and again? Which CDT codes keep showing up over and over as denied? Which of those denials were completely preventable with stronger documentation? And which ones need real escalation instead of one more phone call or one more appeal? Sort them out by carrier and by CDT code. Then quantify because the reason it keeps showing up at the top of that list isn't a nuance, it's a pattern. And it's telling you exactly where to point the needle, where we need to focus. The goal here isn't to add more data to review, it's to let the data guide you straight to the areas that actually deserve your attention. And the very same thing plays out with your write-offs because most practices can tell you how much they wrote off last month. But very few offices can tell you if any of it was appropriate. I have walked into offices with dozens of delta dental fee schedules loaded into the practice management software, all of them cranking out inaccurate patient balances and also unnecessary adjustments because nobody ever had a system for maintaining those fee schedules over time. So I encourage you to go take a look at your fee schedule list. Do you have duplicates? Go count them. Open your software and look at how many fee schedules you've got loaded for a single payer. Like how many Delta Dentals do you have? And if there's more than one, consolidate down to the correct fee schedule and then put a rule in place so nobody can slip a duplicate back in. That's a training opportunity, right? Identify the pattern, clean it up, and then close that door. This is not a billing problem, friends. This is a systems problem. And systems problems get solved through visibility, training, and accountability. Okay, moving on. Then there's the one report

Get Curious And Group By Payer

SPEAKER_00 18:16

I really want you to stop avoiding. This is the claims correction list. This is not in your practice management software. This thing is absolute gold. It creates visibility where there used to be none at all. Sort it by denial reason, by the payer, count how often each one repeats. And once you can see the pattern and you can trace it backwards to wherever it actually started, that is going to be where the gold sits. You're going to see the patterns where they were created, like the root cause of that pattern. Did this delay start at the front desk? Is there a pattern of waiting on clinical notes? Is there a pattern of issues with attachments? Maybe our x-rays are not on point. You are going to name or label the pattern that you identify, and then you're going to train to fix it. So you're not cleaning up the same exact mistake month after month after month. In your monthly billing meeting, you want to put last month's performance percentages right next to the month before, right? So we're comparing two months and lead with the simple question: is the needle moving in the right direction? Anything that got worse becomes a deep dive for that month, right? And that one habit turns a meeting where everybody just reads reports out loud into a meeting where people are actually making decisions, right? And by now we're having better conversations, more intentional questions, and we're able to identify the root cause of some of the patterns that we could not quite figure out how to fix prior to understanding how to read our reports. And so I'm gonna go back to the basics. If you truly want to understand how your billing is going, use the benchmarks that I mentioned earlier in this episode. If there were just two reports that I will pull, if you know I had 15 minutes to do a quick analysis on your practice, I will pull the insurance AR report, run the performance percentages, and then I'm pulling your credit balance report to determine if we have some compliance issues with regards to unclaimed property laws, because those credit balances do fall under unclaimed property. Healthcare does have a time frame to issue refunds to patients. Now, you are not allowed to keep credit balances on file in most states beyond three years, but you do have to check. Some states go as long as five years. But once you have reached that time limit, you have to do your due diligence to find the patient. And if you're unable to locate, you do have to send

Patient AR And Credit Balance Risks

SPEAKER_00 21:26

that money to the state as unclaimed property. That is compliance. That is understanding the full gamut of what a biller should be managing. Because we're not just managing outgoing claims and posting payments. There's a lot more to understand. And these KPIs, these metrics, especially those insurance AR performance metrics, those are going to tell you truly how your billing department is doing. Now, that's not to say that there's not a ton of other things that we need to understand, but for all intents and purposes of this episode, I literally just want you to be able to look at your insurance AR report and determine what percentage each of those buckets are performing at. So by now, you're probably feeling the theme running underneath this entire series. Everything really does come back to visibility, friends. The foundation gives you structure, your roles give you ownership and accountability, your workflows give you consistency, and the claims correction list gives you visibility before reimbursement even begins. And your KPIs give you visibility after reimbursement begins. And each one of these pillars keeps building on the one before the other until your billing department finally stops running on emotion and instinct and starts running on true evidence. And this honestly is exactly the work we dig into during implementation. Okay, so you can absolutely run the dental billing toolkit on your own. I'm now I'm talking about the toolkit because I built it to be used that way so that you as an individual are able to take that information and implement. But a lot of practices choose to work with me anyway. And it's almost never because they need more information. It's because they need someone to help them interpret what they're seeing, help them decide what matters most right now, and help them get the framework in place fast enough to actually feel the difference. Because sometimes the quickest path forward isn't learning one more concept. It's having someone sit beside you and connect the dots between the reports so that you can make the decisions you've been trying to make for months. So I want you to imagine just for a second what it would feel like to open your reports each month and not have to wonder whether things are getting better, to sit down across from your biller already knowing which questions actually matter and to catch your team doing well and be able to praise them for it because you finally see the progress instead of only noticing when collections takes a dip. To make your decisions from

Denials Trends And Fee Schedules

SPEAKER_00 24:51

real evidence instead of your gut feeling. That's the game changer. That is what great leadership actually looks like. Great leadership is building an environment where the right information is visible and the right conversations are happening, and the right improvements keep getting made consistently over time. So here is your homework assignment this week. And this is a simple one, friends. I want you to pull your insurance AR report, pull your patient AR report, pull your credit balance report. If you can identify your top denial reasons, great. But if you can't, at this point, start documenting them. I want you to also start calculating your write-offs. And if you have not already done so, I want you to start where we start. When we work with an office that has billing systems, well, lack of billing systems, in other words, no billing systems. We start with the claims correction list and then we spend a lot of time reviewing the patterns and determining what story the reports are trying to tell us. When you implement the claims correction list, which by the way, friends, I made available at no charge. You can go grab your copy of the claims correction list so you can have to purchase the toolkit to get it. You go to the show notes, this episode show notes, and there's a link there for you to go and grab your copy. It's at no charge. I want you to implement the claims correction list. And once you start seeing the patterns of all the bottlenecks that you didn't even know you were experiencing, once you start to see that, you can't unsee it. And your questions get better. Your training is more focused. You know exactly how these issues started in the first place. It is absolutely amazing to watch the patterns emerge and you get to just start focusing on resolving and training. And then you close the door on that pattern and you monitor and make sure that that doesn't start to emerge again. I think what's going to happen once you implement the claims correction list is you're going to discover that the answers you have been searching for have been sitting right in front of you the whole time. Now, if reading those reports feels overwhelming, friends, I would genuinely love to help. I offer a complimentary billing performance consultation where we sit down and review your billing department together

Claims Correction List And Homework

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and find your biggest opportunities for improvement. And you get real clarity around what your what your reports are actually telling you, or and whether you decide to work with us at Fortune Billing Solutions after that, or you simply walk away with understanding your practice better than you did before. My entire goal is for you to leave with confidence, direction, and a clear path forward. You'll find the link to schedule your complimentary consultation waiting for you in the show notes. And if you're ready to start building the systems we've been walking through all series long, I encourage you to go grab your copy of the dental billing toolkit because it's the very same framework, templates, workflows, and implementation tools we've used to help hundreds of practices create predictable billing outcomes and stronger financial performance. Thank you for spending part of your day with me, friends. I will see you in next week for one of my favorite conversations of this entire framework: Denial Management and Escalation, where we are going to talk about why so many practices have been accepting no from an insurance company when the evidence says the answer should have been yes. Until next week's episode, friends, continue to fight the fight with the right tools. See you next week.