The Dental Billing Podcast
Dental billing is not data entry. It's the difference between a practice that collects what it earned and one that writes it off and calls it the cost of doing business.
The Dental Billing Podcast is hosted by Ericka Aguilar and Jen Lyman, RDH. Ericka has been a dental biller since 1998 and has taught billing in 31 states and Mexico. Jen came out of the operatory and now runs Lyman Revenue Solutions, handling both dental and medical billing. One of us knows exactly what the carrier is going to do with your claim. The other one knows what actually happened in that chair. You get both.
Every week we break down denials, appeals, coding, and the carrier behavior nobody warns you about, in plain language, with real sources. We teach the law before the codes, because a code doesn't win an appeal. Knowing what that carrier is legally required to do wins the appeal.
If you've ever been told you're "just the biller," this show is for you. Downloads in 114 countries and counting. Bring your coffee and your worst denial.
The Dental Billing Podcast
Inside a Dental Billing Company: Password Chaos, Dentrix-Vyne Fallout, and the AR Trap
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A candid look at why AR rises even when production is strong and how access, clarity, and team alignment restore cash flow. We share the biggest blockers we see inside practices—password chaos, clearinghouse issues, unread billing emails—and the simple systems that fix them.
• password and portal access as revenue gatekeeper
• EFT lockouts creating delays and aged AR
• Dentrix–Vine fallout and claim tracing discipline
• daily email reviews and statement ownership
• patient AR rising from unclear benefits and silence
• stronger benefit scripts to prevent “surprise” balances
• third-party alignment as team extension, not threat
• kickoff meetings for roles, tools, and expectations
• billers as end-of-cycle auditors spotting root causes
• repeatable rhythms for faster posting and fewer denials
If any of this resonated with you friends, feel free to leave a review, feel free to leave a comment, share this episode with someone who you feel would relate. And if you're interested in a billing consultation and seeing how fortune billing solutions can help you, go to the show notes. There's a link down below, and you can set up a time to meet with me.
Registration Link for Diagnosis Codes on a Dental Claim Form Webinar:
https://dentiqhub-diagnosis-codes.vercel.app/
Get your Dental Billing Toolkit Here:
https://www.dentalbillingdoneright.com/the-dental-billing-toolkit
Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:
Schedule a billing chat with Ericka:
https://calendly.com/ericka-dentalbillingdoneright/30min
Email Ericka:
ericka@dentalbillingdoneright.com
Email Jen:
jen@dentalbillingdoneright.com
Hey guys, welcome back to another episode of the Dental Billing Podcast. This episode is literally just off the cuff. It's just because I feel the need to talk to you about some of the things that we experience on the inside of a billing company and the challenges that are presented and the things that we do to solve those challenges because you may be experiencing some of these things in your practice. And I want to be able to share that with you so that we can maybe shed some light on some common challenges that we're seeing today. Okay, here's the deal. The biggest challenge that we face
Why This Off-The-Cuff Briefing
SPEAKER_00with our practices is the usernames and passwords and the sharing and keeping of passwords as a third-party billing company. I wish there was a way that, you know, I could wave my magic wand and we could create our own third-party setup with each plan to for your practice, if that makes sense. So like Fortune Billing Solutions has its own third-party access to your portals so that we don't have to wait on an office to give us the code that goes to your email. And I understand that there's a way to
Portal Access And Password Bottlenecks
SPEAKER_00solve that problem, but it seems to bottleneck, and especially when we're taking over from a different third-party billing company and they've created their own usernames and passwords, or you know how sometimes you just have to change your password every so often. It just presents a real bottleneck to the whole process. And especially if the office is predominantly EFT and we are having challenges accessing things like Echo or one of the portals where it's all EFT. I mean, that's happened where we've been locked out for weeks at a time because the office just is not making it a priority to get to that challenge to give us access and post those EFTs. Meanwhile, you've got your AR that's growing because we're not able to access these portals. So that's been a big challenge, I think, universally. Some offices really have their act together with regards to organization with passwords and usernames, and I really appreciate that. But most offices really have a spreadsheet that hasn't been updated in I don't know how long, and they just kind of expect the third party to update those passwords, and that's fine, we can do that. But here's the here's the takeaway from this challenge. If you expect a third party to update your passwords, then give them proper access, give them access to the email account or create an email account specifically for the
EFT Lockouts And AR Risks
SPEAKER_00third party so that we don't have to bother you in your day-to-day. Because I know that offices are short staffed these days, so we don't have time for those nuisance calls, but it's really not a nuisance because we want the billing to flow. And without access to these portals, it's almost impossible to make that happen. So, friends, update your spreadsheet or your Word document or wherever you have these usernames and passwords. Please make sure that they are up to date and that your entire team or whoever needs access to these portals has proper access. That is the responsibility of the office. Now I'm sure your third party is happy to help, but ultimately, this is your responsibility within your business to ensure that you have up-to-date usernames and passwords to the insurance portals because without that access, friends, we can't check on claim status. We as a third party do not rely on your clearinghouse reports. We like to get that information, make sure that the claim actually made it over to the insurance company by checking with the insurance itself. We go into the portal and make sure that the claim was actually received, especially with this whole Henry Shine, Dentrix, and Vine situation that is happening right now. We have dentrix offices who are experiencing a lot of rejections. We're finding that a lot of the claims are not making it over to the insurance companies. So there's a lot of claim tracing involved with our dentrix and vine users because that relationship has
Clearinghouse Turmoil: Dentrix And Vine
SPEAKER_00ended. And Vine, if you're using Vine as your clearinghouse as a Dentrix office, it can affect the rejections, it can affect whether or not the claim is going to make it over there because Henry Schein has made it very clear that if they detect any type of affiliation to Vine in your system, they will slowly phase you out of your ability to submit or even print claims to any computer, to any printer. So check with Vine and get with them because they have a whole team dedicated to Dentrix users and helping you work around all of this confusion around what's going on with Vine and Dentrix. So again, reach out to Vine. If you're a Dentrix practice, you can start to experience rejections. Vine has workarounds. So don't panic, but be aware that these are some of the challenges that we're facing as a third party because we have no control over what you choose to use in your practice. You want us to send statements, that's fine. We just have to be familiar. We have to familiarize, or sometimes we already know how to use whatever system you're using to send statements and the payment link and all of that good stuff. So be aware that this whole fine Dentrix relationship being terminated is affecting Dentrix offices, and your claims can start to get rejected. That is challenge number two. I'm going to talk about another challenge that we experience as a third party. We send a daily email out to our clients, right? So every day at the end of the day, you get an email that says, here's how much we posted, and here are the patients with balances. And unless there's been a clear conversation about who is sending the statements, your AR can go up very quick. One of the things that we've noticed as a third party is that a lot of times these daily emails are not being opened. And we do ping our offices, but it's become a challenge, I think, with offices being short-staffed. You know, so we'll send
Daily Emails, Statements, And Patient AR
SPEAKER_00you a little ping. Hey, we see that you haven't opened that email, and you have 10 patients that need statements. Make sure that you open that email and get those statements out. Otherwise, these patients are going to have balances that are going to linger. And when it comes to patient AR, we have found that AR, the patient AR goes up because nobody's paying attention to the balance that is remaining after you have posted and closed out the claims. Sometimes there's still a $400 balance because what we presented to the patient was based on a certain fee schedule and or the coverage we received was inaccurate. And now the patient has a balance. Now, whether or not you choose to send that statement to the patient is on you, but ultimately the patient is responsible for the treatment that they receive. So I don't believe that we should not charge the patient their balance because we can't always anticipate what the insurance is going to pay, especially with all of the network leasing that's happening and their ability to use a different fee schedule. So there's a lot of mystery behind the scenes, you know, things that we are not aware of that are going on behind the scenes with the insurance companies. On the front end, or the front line, I should, I should say, we can't control how the insurance is going to perform on the back end. We just have to have the ability to explain that we don't have control over how the insurance companies pay or what they decide to pay. We those that is out of our hands. And I find a direct correlation between how treatment or how benefits are explained to a patient versus when the insurance underperforms or doesn't pay according to what we anticipated. A lot of treatment coordinators, a lot of front office individuals will avoid that conversation. And guess what happens to patient AR? It continues to rise. And I see this happen a lot. So I think we need to talk more about how to explain benefits to a patient so that we can get ahead of a surprise balance because it's a surprise to you, it's a surprise to the patient. And it's not a good look. But when we know how to handle those types of conversations, and I find that a lot of people don't know how to handle that conversation, it makes it a lot easier. And that is another area that we experience and see as a third party how it affects the practice. Okay, so another challenge that I thought I would discuss with everyone is understanding that a third party is not there to take anyone's job. I have to emphasize that because sometimes the doctor will hire a third party with the intention of helping their team.
Explaining Benefits To Prevent Surprises
SPEAKER_00And sometimes you have a team member that takes that gesture almost offensively, like as if they are not doing a good enough job. Why did you hire this company? I can handle it. When clearly you've got 33 pages of insurance AR, and I don't know how many pages of outstanding claims, and the pre-authorization report is a mess. Patient AR is upside down, but this individual feels that they can handle it. And I'm sure they can. However, when it gets to a level where you've got multiple pages of insurance AR, you've got multiple pages of outstanding claims, you've got multiple pages of procedures not attached to claims. I mean, I can go on and on. It's not a personal attack, my friend. It is literally relief coming your way. And a third-party team is an extension of your team. And we always like to say, we're a part of the team, but we're working behind the scenes. It's really important that our relationships between the third-party companies, because the reality is in dentistry, because we're short staffed, we are going to work with third-party companies to do billing. I've seen third-party companies to do scheduling, to answer the phones, to do treatment coordination, to present large treatment plans. We have offices that have no front office team, and we are it. So we are appointment scrubbing, we are ensuring that chart preparation is done. We are calculating co-payments for the day so that there's no guesswork in what it what needs to be collected. We are ensuring that there's no lingering balances. If a patient is coming in today and they have a lingering balance from a previous date of service, we're going to make sure that we collect that today. Or at least have that conversation, right? And we're doing all of this because doctors are coming to us and saying the same thing. It's the same conversation. I can't find people. And I have interviews, people don't show up, or people come in and they're asking for these inflated hourly rates. So it just makes more sense to hire a third party. So, with that being said, I think it's important that as you grow, especially when you grow your team, it's important to include them, at least give them a heads up because there's so many times when we schedule our kickoff meeting. Once we bring a client on board, we schedule a kickoff meeting, and office managers are just kind of like, well, I guess we're doing
Third-Party Teams And Staff Buy-In
SPEAKER_00this. I didn't know. So, hi, nice to meet you. How what are we doing here? And it makes it very uncomfortable for everybody involved because we try our best to prep the office for this kickoff meeting, but we have no control over who you're going to include. We do suggest that everyone attend, but we realize again, not everyone's going to be able to make it, but we will tell the doctor or the office manager, we suggest everyone attend the kickoff meeting so that everyone understands what our role is. You can express what your expectation is as a team. We can talk about communication tools, we can talk about what ifs. I mean, we can really cover a lot of ground in the kickoff meeting. That's the purpose of it. But unfortunately, that doesn't always happen. So when we take over doing the day-to-day filling and we get into the weeds, right? I always say we got to get into the weeds, we got to find what needs to be fixed and fix the revenue cycle because there's always something to fix, right? When we get in there, we find all of the things. Insurance verification happening, sometimes not happening at all. The breakdown of benefits is not always put into the system properly, which is definitely affecting how you're presenting your treatment to the patient. And we catch all of this. I always say the billers, the catch-all to the practice because they really are. We catch all of this when we're posting the payment. Because when you're posting the payment is essentially when you're closing out this claim and this patient, this interaction is coming to a close. The revenue cycle is closing for this date of service. And in that, we can see how you presented the treatment. Because when I post a payment, I always look at what was presented to the patient, right? Like if something is not a covered benefit, I like to look at how it was presented to the patient. I like to look at what the schedule was used. I just I like to look at the whole the whole picture. So we catch all of the things, and then when we bring it to the office's attention, sometimes it's not well received. And friends, I really wish we could get over this hurdle because for the most part, we don't have a lot of this happening because I think a lot of relationships can be built based on how you say something, not necessarily what you're saying. So we do our best, but then there's still individuals that no matter how hard you try, they are going to not receive criticism. I don't want to call it criticism. I don't know what word I'm looking for here. Constructive criticism as far as what we can do to improve, they get stuck on what you found and how that makes them look. And that is definitely, let me just shout this like to the heavens. That is definitely not what we're trying to accomplish. We're just trying to accomplish improvement. We're trying to accomplish together higher reimbursement. We're trying to accomplish advocating for our patients and getting access to the benefits that the insurance companies are denying. So, you know, when when we're talking about the things that we experience, the things that we see on a
Kickoff Meetings And Role Clarity
SPEAKER_00regular basis, that's it in a nutshell. Password management, it's for dentrix offices in in the current climate. It is dentrix offices that are using Vine, having challenges with that relationship. It is communication with us and the team members. And then finally, those difficult team members that just no matter how hard you try, they're just never going to get on board with working with a third party. So I hope that you took away from this shorty episode that is really, I don't know if it's a rant, but I've just been having so many conversations with my billers expressing frustration around accessing insurance portals. So that prevents them from doing a good job or their job at all in terms of following up on claims, hosting EFT payments. And if you're experiencing that, friends, clean that up, ASAP, because that is the insurance revenue cycles. What am I trying to say? Heartbeat, right? We need access to your portals, or we can't do our job. And we can get the claims out, we can submit claims, no problem. But we really want to be able to post those payments. And if the patients need statements, if we're not sending it for you, then inform you that these patients need statements and why, so that we can make sure that you're collecting the money that you are producing. That's the entire point to the revenue cycle, right? Is to get paid for what you're doing. If any of this resonated with you friends, feel free to leave a review, feel free to leave a comment, share this episode with someone who you feel would relate. And if you're interested in a billing consultation and seeing how fortune billing solutions can help you, go to the show notes. There's a link down below, and you can set up a time to meet with me.
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