How to Choose a Dental Billing Company

What should I ask a billing company before I hire them?

Three things. What is your ratio, meaning how many practices one team handles. How do I reach my account manager, and how fast. And what is your write-off procedure, specifically whether anyone can adjust a balance without asking me first. Those three answers tell you most of what you need to know.

What ratio should I be asking about?

How many practices one team handles, and what a team means. Ours is eight to ten average-sized practices per team, and a team is an account manager, two assistants, and a verification person. Larger practices get a dedicated team. If a company will not answer this question directly, that is your answer.

How fast should a billing company respond?

Immediately, or a call back within a few minutes. If a patient is standing at your front desk with a question, a ticket number does not help you. And if your account manager is unavailable, you should be able to reach the person who manages them right away. Everyone should be accessible to you, the same as if they sat in your office.

That's how we set it up. The About us page is the longer version.

What's a red flag when hiring a billing company?

A ticket system instead of a person you can reach. A/R handled by the same people doing your daily claims rather than a separate team. And the ability to make adjustments without your approval. Any one of those three is worth walking away over.

Why should A/R be a separate department?

Because it is labor-intensive and it competes with today's work. If the same person handles your current claims and your backlog, the backlog always loses, and you end up with an aging report that never gets smaller. A separate team plows through the past while your account manager keeps the present moving.

That's how we run A/R recovery.

Is growing A/R a red flag?

Always. But look closer before you conclude the claims are uncollected. At times, a large share of what sits on an aging report has often already been paid and simply never posted. That is bad record keeping rather than bad collections, and it also makes accurate patient billing impossible.

How do I know if my current billing company is doing a good job?

Look at your adjustments. If your fee schedules are entered correctly in your software, you should have almost none. If you see a crown adjusted down to a filling, that claim was downcoded and somebody posted it instead of appealing it. Growing A/R is the other tell.

Should a billing company be allowed to write off balances?

Not without asking you. Every adjustment should be investigated and approved before it is entered. The cleanest setup is having your fee schedules correct in your software, so your ledger posts the negotiated fee and there is nothing to write off. That also keeps your production numbers accurate if you pay associates on production.

Should my billing company do credentialing or negotiate my fees?

We do neither, deliberately. Both are about getting further in-network and working for a reduced fee, and most of our clients are working the other direction. Credentialing exists for in-network participation, so once you are out of network you do not need it. If you want to stay in network, that is your decision and we will bill it either way.

What do you catch that another billing company would miss?

Downgrades. A crown paid as a filling. Most operations post that payment and move on, because a filling was paid and the claim is closed. We go back and fight it. That is the single most common place a practice loses money without anything appearing to go wrong.

Can a dental practice succeed out of network?

Yes, and practices that do it properly flourish. What separates them is the foundation: new patient flow, a full hygiene schedule, staff trained to answer out-of-network questions, and an office that can effectively present treatment. Practices that struggle are almost always missing one of those four, not the insurance strategy itself.

Do I still file insurance if I go out of network?

Yes, and we recommend it. Out of network does not mean out of insurance. You still file claims, still accept assignment where the plan allows, and still verify benefits before the appointment. The difference is what you charge and what you collect, not whether you deal with carriers.

Do I need to stay credentialed once I'm out of network?

No. Credentialing exists specifically for in-network participation. Once you are out, it serves no purpose. We do neither credentialing nor fee negotiation, deliberately. Both are about getting further in-network. Again, stay in if you want, we'll bill it either way.