Built to Get Paid Series - The Workflow Engine (Part 3 of 6)

You can have hardworking people and still have a billing department that feels like a black box. Claims get submitted, denials appear, balances age, and everyone assumes follow up is happening, but nobody can point to where the work actually stalls. We dig into the “workflow engine,” the third pillar of the Fortune Billing Department Framework, and show how visibility is the missing link between dental production and predictable collections.

We walk through the practical tools that turn vague frustration into clear data. The big one is the claims correction list, a simple but powerful way to track why claims are not moving through the insurance reimbursement cycle. Insurance aging reports tell you what is overdue, but the claims correction list tells you the real reasons: incomplete clinical notes, missing narratives, missing x rays, additional information requests, and repeat documentation gaps that create denial patterns. When you can name the bottleneck, you can train, coach, and fix the process instead of chasing balances.

From there, we layer in daily and monthly rhythms that keep the revenue cycle healthy: an end of day billing report that creates real time communication between the billing team and leadership, plus a monthly billing meeting where trends become strategy and decisions are made by facts instead of assumptions. We also talk about building a structured billing calendar with owners and deadlines so “I’ll get to it when I have time” stops costing you money.

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Transcript

Listener Shoutout And Why It Matters

SPEAKER_00 0:00

Before we jump into today's episode, I want to take a moment to give a very special shout out to someone who has been a longtime listener of the Dental Billing Podcast, someone I've had the privilege of mentoring over the years, and someone whose journey makes me incredibly proud. Her name is Maria. Many years ago, Maria and I spent countless hours together in coaching sessions talking about dental billing, insurance claims, documentation, all the little nuances that make this profession both challenging and rewarding. Like many of us, she started with a desire to learn the craft. And over time, she developed her skills, built her competence, and created something truly special. Today, Maria owns her own dental billing company and teaches dental billing to individuals who want to enter the profession. Here's what I admire the most about her business. She has created a niche that serves a very specific need in dentistry. Maria teaches her courses in Spanish and has dedicated her business to supporting a demographic that is often underserved when it comes to high-quality dental billing education. Recently, Maria purchased the dental billing toolkit and sent me a message that absolutely made my day. She wrote, I just wanted to say how much I'm enjoying the dental billing toolkit. It's full of great information and I especially love the templates. They are so practical and helpful. Thank you for creating a valuable resource. You did an amazing job. Maria, if you're listening, and I know you are, thank you for your support. Thank you for your kind words. And thank you for the work you're doing to educate and elevate the next generation of dental billers. Watching your journey from student to business owner has been one of the most rewarding parts of my career. And I am so proud of what you built. Thank you for allowing me to be a part of your journey. Now, let's get into today's episode because this conversation ties directly into something I've spent years teaching inside of coaching sessions, workshops, and consulting engagements. Today we're diving into the third pillar of the Fortune Billing Department Framework, the workflow engine. If you've been following this series, then you already know that the foundation pillar focused on setting the practice up correctly. We discussed everything from UCR fee analysis, insurance participation strategy to coding architecture and demographic research because I firmly believe that every successful billing department begins with intentional design. In our second pillar, we mapped out the various roles that contribute to reimbursement and explored why billing truly is a business within a business. We identified the responsibilities of the doctor, assistant, hygienist, front office, tracer, compliance officer, and manager because accountability cannot exist without ownership. Now we arrive at the third pillar. And in many ways, this is where everything begins to come together. One of the questions I ask doctors when I first meet them is whether they feel like progress is being made in their billing department. Surprisingly, or unsurprisingly to me, a lot of doctors don't even realize that they have a

Pillar Three And The Visibility Gap

SPEAKER_00 3:51

billing department. Interestingly, very few answer that question with certainty. Most tell me that they think progress is being made. They believe that claims are being submitted and they assume follow-up is happening consistently. They are hoping that denials are being appealed, and they trust that patient statements are being sent. The common theme in this conversation is that they actually don't know. That uncertainty is what led me to develop the workflow engine. Over the years, I've learned that most billing departments are not struggling because of people or lack of talent. They're also not struggling because the team is unwilling to work hard. More often than not, they are struggling because there is very little visibility into how work moves through the billing department. Tasks are assigned verbally. Follow-up happens when someone remembers. Appeals get worked on when someone has time. And I find that offices often have a stack of additional information requests just sitting there waiting for someone to work on them. Clinical notes are completed at some point. And everyone is working, but nobody can clearly articulate where the bottlenecks exist or how much money is trapped inside of unfinished work. And I want you to think about that phrase for a moment. Trapped inside unfinished work. When we look at insurance aging reports, we're looking at money that has already become delayed. The claim has already stopped moving through the reimbursement cycle. And the aging report tells us that there is a problem. A problem exists, but it does not tell us why the problem exists. If we want predictable billing

Claims Correction List As A Lens

SPEAKER_00 5:59

outcomes, we need to learn how to identify workflow issues before they become aging issues. I remember reviewing a claims correction list for a practice and discovering after reviewing it and tallying up how much money was tied to unresolved workflow issues, we had about $194,000 tied to things like clinical notes, it being incomplete. That's one of the main issues. Because one of the rules of thumb inside of Fortune Billing Solutions is that we do not submit a claim unless clinical notes match what we are placing on a claim form. And that should be the rule of thumb for every biller out there because we are protecting our doctor's license. And if we are submitting claims before their clinical notes are complete, we could unfairly be paid for services that we didn't do because we thought that the doctor did X when in fact the doctor did Y. So we want to make sure that we have a strong understanding set of rules that we all adhere to. So going back to reasons why claims were being just stuck in the reimbursement cycle, incomplete documentation was, you know, could be missing. We might be waiting on narratives. We didn't take the right x-ray. There's a series of small unfinished tasks that had accumulated into a very large financial problem. The office often believes that they have an insurance AR problem. And what they actually have is a workflow visibility problem. So that experience reinforced something I now teach in every workshop I present. Most offices spend their time reviewing reports that tell them what happened. And very few offices spend time reviewing reports that tell them why it happened. If your goal is to create predictable collections, then understanding the difference between those two reports is essential. That's why the claims correction list became such an important part of the dental billing toolkit. Many people assume the claims correction list is simple is simply a spreadsheet and that it's used to track missing information. The reality is it has evolved into one of the most valuable management tools we use at Fortune because it reveals much more than missing documentation. It reveals patterns, it reveals communication breakdowns, it reveals workflow bottlenecks, it reveals training opportunities, reveals management challenges that were completely invisible before the report was introduced to the practice. I often refer to the claims correction list as the big sister of the insurance AR report because those two reports serve very different purposes. And the claims corrections list is external from your practice management software. This is not a report you're going to be able to find inside your practice management software. The claims corrections list tells us why that money has not been collected. An insurance AR report can tell me there's 150,000 outstanding. The claims corrections list can tell me that 25,000 is waiting on clinical notes, 12,000 is waiting on x-rays, 18,000 is sitting in additional information requests, and another 9,000 is waiting on narratives. Those insights completely change the conversation because we're no longer discussing just the balance. We're discussing behaviors, workflows, and bottlenecks that can be corrected. What makes this report particularly powerful, friends, is that it teaches management how to see. I review a claims correction list and notice that claims are consistently waiting on one provider's clinical notes. I am not looking at a billing issue. I'm looking at a workflow issue that requires intervention. That's a training opportunity, or that's an opportunity to have a very specific conversation with that provider. If I repeatedly see requests for pre-buildup intraoral photos, I'm not looking at a billing issue. I'm looking at a training opportunity with a clinical team member and teaching them when and how and what we need in order to get paid for the buildup. If period claims continue requiring corrections because bleeding points are not being documented appropriately, I'm again not looking at a billing issue. I'm looking at a documentation process that needs improvement. The report transforms assumptions into data, right? So before the claims correction list, management feels like something is wrong. After we implement the claims correction list, management can see exactly where the breakdown is occurring. And once something becomes visible, it becomes manageable. That visibility is the foundation of every successful workflow because people cannot improve processes they cannot see. One of the reasons the claims correction list has become such an important part of our workflow is because it gives us the ability to identify workflow breakdowns before they evolve into larger collection problems. By the time a balance appears on an insurance AR report, the delay has already occurred. Somewhere along the way, the claim stopped moving, whether it was waiting on clinical notes, waiting on documentation, waiting on a response from the office, waiting on additional information to be submitted to the insurance company. When you begin reviewing the insurance AR report and the claims correction list together, something interesting starts to happen. And I love this part. You stop looking at AR as a collection problem. You start looking at it as a work as a workflow problem. Instead of asking why insurance hasn't paid, you start asking what prevented the claim from moving through the system the way it was intended to. Those are very different conversations, friends. And in my experience, the second conversation is where that meaningful improvement is going to occur. This naturally leads into another tool within the toolkit that often surprises practice owners when they begin using it. And that's the end-of-day billing report. One of the most common observations I make when working with doctors is that they have very little visibility into what happens after treatment is completed. They know the patients were seen, the procedures were performed, and the production was generated throughout the day because they were directly involved with those activities. What they often do not know is what happened after the patient left and the billing process began. Without a structured communication process, it becomes difficult for leadership to understand whether claims were submitted, whether payments were posted, whether appeals were filed, whether statements were sent, the billing team, you know, whether the billing team encountered obstacles requiring support. Over time, the lack of visibility creates assumptions. And assumptions are rarely an effective management strategy, friends. The end-of-day billing report creates a consistent communication cadence between the billing department and the practice. It provides leadership with a summary of completed work. It identifies unresolved issues and highlights any items requiring attention from the doctor, the office manager, or the clinical team. Rather than waiting until a monthly meeting to discover that claims have been delayed or documentation has been missing, the practice receives that information in real time while corrective action can still be taken.

End Of Day Billing Report

SPEAKER_00 14:56

What I have found is that accountability improves significantly when visibility becomes part of the daily workflow. Team members understand that unfinished work will be identified, bottlenecks will be discussed, and progress is going to get communicated. The goal is not to create additional reporting. The goal is to create alignment with the end-of-day email. When the billing department, clinical team, office manager, and doctor are all operating from the same information, decision making improves and workflow becomes substantially more predictable. The next component of the workflow engine is the monthly billing meeting. This is where patterns become strategy. Data without discussion is just noise. Reports do not improve collections. And I want to say that for the people in the back so that you everybody hears this. Reports do not improve collections. Conversations about the reports and the data within the report improve collections. So during our monthly billing meetings, we review insurance AR, claims correction trends, denial patterns, write-off activity, outstanding projects, commissioner escalations, and any recurring bottlenecks that continue to interfere with reimbursement. The purpose of the meeting is not to point fingers. Purpose is to identify opportunities for improvement and ensure the department is moving in the right direction. This is also where we begin teaching offices how to manage by data instead of emotion. Too many management decisions are based on assumptions, friends. Someone feels like collections are down. Someone thinks insurance is paying slower. Someone believes the billing team is behind. The monthly billing meeting replaces assumptions with facts. And facts are what you should be making decisions with. The final piece of the workflow engine is creating a structured

Monthly Billing Meeting That Drives Change

SPEAKER_00 17:12

billing calendar and project management system. One of the most expensive phrases in dentistry is I'll get to it when I have time. Claims don't care when you have time, friends. Appeals don't care if you have time. These, there are certain things that must happen every day in order to have successful outcomes. And these do not depend on whether or not you have time. Every one of these items has a deadline attached to it. And every one of those items has the ability to impact collections if it is ignored or treated as a task that you get to when you have time. Every project inside the billing department should have an owner. It should have a deadline and visibility. Denial management is a project. AR cleanup is a project. Credentialing is a project. PPO participation, reviews, and are projects. Nothing should exist as a floating task that lives inside of someone's memory, inside of someone's head. If a task or task management project lives inside your head, your system is not reliable. That is the difference between a reactive billing department and a predictable billing department. Okay, here is this week's homework assignment. This week, I want you to complete a workflow

Billing Calendar With Real Ownership

SPEAKER_00 18:44

audit. Start by pulling your insurance AR report and create a claims correction list. You can find the exact template that we use inside the dental billing toolkit. Review them. I want you to create them and then review them side by side and start identifying the top three workflow bottlenecks currently preventing claims from moving through the reimbursement cycle. Do not focus on the dollar amount first. Focus on the reason. What is causing the delay? Is it documentation? Is it clinical notes? Is it missing attachments? What is going on with your top three bottlenecks? Then I want you to assign ownership and place those items on a shared calendar. The goal is not to solve every problem this week. The goal is to create visibility. If you're working through this assignment and realizing that your billing department depends heavily on what's in someone's head, verbal communication, or even worse, a bunch of sticky notes, and hoping someone remembers to do something, friends, you're not alone. I have this conversation five to six times every day with different dental practices. Most practices don't realize how much money is trapped inside unfinished work until someone helps them uncover it. If

Workflow Audit Homework Assignment

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you would like a second set of eyes on your workflow, if you need help implementing your claims correction process, your insurance AR, or your overall billing infrastructure, schedule a complementary strategy call with me. We'll identify the bottlenecks, discuss opportunities for improvement, and determine the next best step for your practice. Before I let you go, I want to share something important. For the last several months, Fortune Billing Solutions has operated under a new client freeze because we made a commitment to our existing clients that growth would never come at the expense of service. We focused our attention on strengthening our systems, improving our processes, and developing exceptional results for the practices we already serve. The good news is that we are opening our doors again, and perhaps for the final time this year. If you're currently working with a billing company and you're not seeing the communication, accountability or results you expected, or if you're managing billing internally and wondering whether there is a better way, I invite you to schedule a conversation with our team. No pressure, no sales presentation, just an honest discussion about where your billing department is today and where you want it to be. Because at the end of the day, our mission has always been the same helping practices create predictable billing outcomes, stronger systems, and healthier collections. I will see you in the next episode as we move into pillar number four of the Fortune Billing Department Framework.