Built to Get Paid: Introduction to The 6-Part Billing Framework Series

If your practice feels slammed but collections still don’t line up with production, that’s not “just insurance.” That’s a billing system problem, and it’s fixable. We walk through the exact framework we’ve used to help hundreds of dental offices and group practices streamline dental billing, reduce denial chaos, and create predictable cash flow without gatekeeping or overcomplicating the work.

We break billing down into six pillars that build on each other: foundation, roles, workflows, compliance, metrics, and growth. You’ll hear what “foundation” really means in a dental revenue cycle, including practice management software setup, accurate codes, mapped procedures, fee schedules that match payer contracts, and credentialing that prevents avoidable delays. We also share why every practice needs a billing command center, a single source of truth for portals, passwords, processes, and payer details, so the department doesn’t collapse when one person is out.

Then we move into role ownership and workflow engine design so claim follow-up, denial management, and old AR cleanup stop being optional. We talk about using simple project management tools to keep billing work on a calendar, why consistency is what drives consistent insurance collections and patient collections, and how compliance and documentation protect everything you’ve built. We close with the metrics that matter, like insurance AR over 60 days, write-offs, and collection percentages, plus the reality that clean reports aren’t always honest reports, and why a growth loop of training and auditing keeps your billing department future-proof.

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Perio performance formula:

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Transcript

Why Billing Must Be Predictable

SPEAKER_00 1:10

I am actually sitting here staring at the six pillars. These are the foundational pillars that I have used for so many years in streamlining and creating in-house billing teams for large groups. The first pillar is the foundation. And inside each pillar are different buckets that we focus on and execute in order to set the foundation. It includes things like setup, mapping out your procedures, then coding those interactions, and so much more in the foundation pillar. The next pillar is our roles pillar. So this is where we define roles. We are not going to say that Sally is the biller and Brenda is the poster and Daryl is the AR cleanup person. We're not taking individuals, but what we are doing within the roles pillar is defining which roles are needed in order to have a sufficiently running billing department. And sometimes it's just one or two people. That's okay. The next pillar is going to be our workflows pillar. And this is where it gets really tactical. And this is where we tell anybody who's coming to work with us in our practice how we do business. This is how our billing department codes. This is how our billing department posts payments. There's a flow and there's a drumbeat. That's where the drumbeat is created through all of these workflows. The next pillar is compliance. And this is where we talk about clinical documentation. We create templates. We make sure that everything we're doing is within compliance. We have compliance assign a compliance officer. Very, very important pillar. The next pillar is our metrics pillar. And this is the one that management is going to use in order to determine if things are trending in the right direction. Do we need some help? These are the key metrics that we will outline and then measure upon, measure the results against so that we can determine if we're going in the right direction or are we needing some coaching here. And the final pillar is what we refer to as our growth pillar. This is where we have ongoing education, continuing education around one of these pillars. So once a month, we're doing some type of education with our team, intentional to help anybody working in the billing department grow within their position. These six pillars have helped literally hundreds of dental offices streamline their billing department and help maintain through the metrics, through the growth, help maintain a healthy billing department because billing friends should be predictable. So, with all of that being said, I kind of jumped ahead a little bit before I talked about what I really want to talk about on this episode. As I mentioned earlier, billing should be predictable. It is not perfect. Billing is never going to be denial free, but it should be predictable. You should have a general idea of what's coming in, what's outstanding, and what needs attention. So if your numbers feel like a surprise every month, then definitely something is off with the foundation, with the structure. That's why I'm going to release this series, and I'm calling it built to get paid, because billing is not something you do when you have time. It's a system that should be built, maintained, and followed. Over the next six episodes, I'm going to walk you through exactly how we structure and scale billing departments inside practices, single practices, and group practices across the country, friends. We've done this hundreds and hundreds of times. This is a process that works if you're a startup. And it's also something that works for, say, an existing practice where the billing department just seems like it's a runaway train and you have no idea how to catch it. We are not going to gatekeep, and I am definitely not going to overcomplicate it. I'm just going to give you real structure. So what I see every day is like on a hamster wheel. It's like the same challenges, the same billing conversations on a loop, claims being sent out, incomplete. There's no consistency in follow-up. And I always say for the fortune is in the follow-up. I have said that so long. I actually named my billing company Fortune Billing Solutions because I am a strong believer, not just in billing, friends, and incomplete treatment. The fortune is in the follow-up, right? Denials don't get followed up on until someone has time. Reports that look clean, but they're not necessarily accurate, and you don't know how to tell whether or not somebody is manipulating the information. And then the doctor is sitting there trying to figure out why production is there, but collections aren't matching. That to me is one of the most common statements I hear from dentists when we're talking about insurance collections or just collections in general. Very common statement. We're busy, but it's not showing up in the bank account. I'm not sure what's going on. And that's when my spidey senses go off because there's something wrong, right? There's a gap in the billing system or lack of one, lack of billing system. So instead of giving you random tips, I'm going to gift you our framework, six-part framework. And each one builds on the other. Every Tuesday, we're going to take one piece and break it down so you can actually apply it. We're going to go through the foundation. This is your setup. And I'm telling you right now, most offices skip or rush through this. Your practice management system needs to be dialed in. Your fee schedules need to match your contracts. Your codes need to be accurate. Your procedures need to be mapped out correctly, not close enough. They need to be correct because if your setup is wrong, you're creating problems before the claim ever leaves your office. So this is where credentialing lives. If your providers are not properly credentialed and linked, you're setting yourself up for denials and delays. And then there's something I push for in every office. I call it a billing command center. I don't care if it's a Google Drive, a shared folder, Monday.com, Asana, but you need to have one place where everything lives passwords, insurance portals, credentialing details, fee schedules, internal processes. Because if your billing depends on one person's memory, you don't have a system, my friend. You have a liability. The second pillar, and I mentioned this earlier, but I'll go into a little more detail, is the roles map. This is where things start falling apart in a lot of offices. Everyone is doing a little bit of everything. The front office is halfway billing, the biller is fixing front office mistakes, the doctor doesn't know what's happening but wants results. That does not work. Every part of the billing process needs ownership. Who's responsible for claim creation? Who's responsible for checking documentation? Who's responsible for follow-up? Clear roles create accountability, and accountability is what keeps money from slipping through the cracks. And I want to be very clear when I say this. When we lose money in the billing department because we don't have proper systems in place, this is what I refer to as leaking profit. So this doesn't even make it to your profit and loss statements. Like this is loss before you can actually claim a loss. And this is why I'm so adamant about making sure that we have roles outlined and implemented, not according to a person, but according to what the billing department needs, if that makes sense. The third pillar is where we spend time talking about the workflows, the workflow engine. This is your daily operation. And I want to I want you to hear this clearly. Nothing in the billing department should be a when I have time task. Nothing. Claim follow-up is not optional. Denial management is not optional. And posting payments correctly is not optional. These are scheduled responsibilities. This is where project management tools come in. If you're not using something like Monday.com or Asana, you're making this harder than it needs to be. Billing is a series of projects, and project management tools are so helpful. Claim follow-up is a project. Denial management is a project. Old AR cleanup is a project, and projects have timelines. Your billers should have a calendar. They should know what they are working on each day, each week, each month, not guessing, not reacting, following a schedule because consistency in workflow is what creates consistency in collections. It's like sales. No outreach, no sale. More outreach, more sales. So consistency in project management is going to mean more consistency in your collections, not just insurance collections, friends. I'm talking patient patient collections as well, OTC collections, over-the-counter collections. The fourth pillar, the compliance shield. Now, now this is where we're going to protect everything we just built. This is where we talk about doing things the right way, submitting claims with proper documentation, making sure that your billing actually supports medical or dental necessity, not billing something just because the patient is eligible. I see a lot of that. And also understanding when insurance companies are crossing the line, understanding your state and federal laws and how they apply to your practice. Because part of your role in billing is being an advocate for the patient, not just sending claims and hoping that they're going to get paid. It's really advocating for your patient's benefit so that they receive the benefits they're paying for. The fifth pillar is our metrics dashboard. If you're not measuring it, you don't actually know what's happening. And I'm not talking about glancing at a report once a month. I'm talking about understanding your numbers. I'm going to go story time on you just a second. I used to work for a prostodontist, and every month we would have these billing meetings. And I will tell you, friends, I had no idea what I was looking at. I would meet with my doctor like clockwork every month, and I would explain balances where I was, you know, with follow-up and things like that. But it was so surface level, generic. And honestly, I see looking back how if I knew and understood on a deeper level what I was doing in those meetings, we could have made such a bigger impact because AR was a problem. And I was trying my very best to clean it up, but it was at the beginning part of my billing career. So I was still learning a lot. I understood the basics, but when we dial in and our team truly understands metrics and how to interpret reports, oh my gosh, it's a beautiful thing. I'm talking about truly understanding your numbers, insurance AR over 60 days, your zero to 30 column, your write-offs, your collection percentages, and more importantly, knowing when those numbers don't make sense because a clean report is not always an honest report. And I'm going to talk about that more when we get into that pillar. The final pillar is the growth pillar. We call it the growth loop. This is where you take everything to the next level. Training the team, auditing your systems, adjusting based on patterns you're seeing. Billing is not static. Insurance changes, regulations change, and your systems need to evolve with that. If you're not improving your billing department, it is falling behind. I promise that. So I hope that you're gonna join me every Tuesday for the next six weeks to go into detail for each pillar within this framework. That again, I've been using this framework for almost a decade now with offices helping them restructure or set up for the startups. It's a six-part framework. And here's what I want you to take away from this first episode. Billing should be predictable. If it's not, it's not because insurance is difficult. It's because something within your system was not built correctly or not being followed consistently. Next week, we're starting with the foundation. We're going to go deeper into setup and I'm gonna show you exactly where most offices get this wrong before they even submit their first claim. New episodes are gonna drop every Tuesday. And if this episode made you think about your current setup, send it to your team. Have them tune in every Tuesday because we're gonna go deep. This is not a one-person fix. We're talking about a billing department. And you guys know that I'm a firm believer that you need to treat your billing department like a business within a business. And when it's built right, everything else in your practice gets easier. I'll see you next week where we go over the foundation.