Got questions? Send Ericka a Text!

Are you leaving money on the table while your patients remain undertreated? After analyzing over 300 dental practices across the country, I discovered a shocking truth: the average dental practice with a full-time hygienist treats only 17% of the periodontal disease they diagnose. That means 83% of diagnosed disease goes completely untreated—a staggering gap between diagnosis and care.

This episode dives deep into the "hidden opportunity" within your hygiene department by exploring D4346: scaling in the presence of generalized moderate to severe gingival inflammation. This often-misunderstood code bridges the critical gap between a standard prophy (D1110) and scaling and root planing (D4341/D4342). For patients showing clear signs of gingivitis without bone loss—bleeding on probing, inflamed tissue, pseudopockets, and plaque that doesn't respond to routine cleaning—continuing to perform prophies isn't prevention; it's undertreatment.

I walk you through a comprehensive, step-by-step process for properly implementing D4346 in your practice, from accurate diagnosis and bulletproof documentation to effective patient education and ethical billing. We cover common challenges including insurance downgrades, particularly when carriers like Delta may pay less for D4346 than for a prophy, and how to handle these situations without compromising ethics or revenue. The key message: this code is based on diagnosis, not difficulty or time spent, and represents therapeutic care designed to heal tissue, not maintain it.

Whether you're a dental biller, office manager, hygienist, or dentist, this episode provides practical guidance for transforming your approach to gingivitis treatment. The benefits extend beyond proper coding—you'll deliver better care, improve patient outcomes, and optimize practice revenue. Pull a few charts this week and see how many of your "prophy patients" actually qualify for D4346. The results might surprise you.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

Dental insurance verification is stuck in the 1990s, but insurance companies have dramatically changed how they operate—leaving dentists with surprise balances, frustrated patients, and a mess of accounts receivable. In this eye-opening episode, I reveal how insurance carriers are secretly leasing networks behind the scenes and potentially pulling your practice into networks you never directly signed with.

Drawing from a recent consultation where a practice saw their AR spike by $70,000 due to inadequate verification, I walk through exactly why checking just the basics—deductibles, maximums, and coverage percentages—is no longer enough. The game has fundamentally changed. Through leased networks and umbrella plans like Connection Dental and DentaMax, carriers can apply completely different fee schedules than you expect, even when you think you're out of network.

Most importantly, I share the specific questions you must ask during insurance verification to protect your practice: Are we in-network or out-of-network with this specific plan? Are we directly contracted or leased through another network? Which fee schedule applies to our office for this plan? Does this patient's plan fall under a specific PPO tier, group or level? These questions will transform how you set up patient accounts and present treatment plans.

Ready to stop the bleeding and take control of your insurance verification process? Download my free verification checklist in the show notes and start mapping your complete network participation status today. Your billing department—and your bank account—will thank you.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

Insurance companies are using AI to evaluate dental x-rays, denying claims when specific landmarks aren't visible in the images. This shift means approximately 70% of claims are now processed through artificial intelligence systems that disqualify submissions based on technical deficiencies rather than subjective human review.

• Poor quality x-rays with cone cuts or missing apexes give insurance companies legitimate reasons to deny payment
• Clinical teams need training to understand what qualifying x-rays look like for different procedures
• Billing starts with proper clinical documentation and supporting attachments, not in the billing department
• Digital x-rays allow immediate quality assessment - retake poor images immediately
• Even the best billers can't overcome insufficient evidence when appealing denials
• Creating a list of procedures requiring x-rays and examples of qualifying images can help train staff
• When benefits are available and evidence is sufficient, insurance companies should pay claims
• Proper documentation creates leverage when fighting unreasonable claim denials

If you need help training your clinical teams on how to improve x-ray quality for insurance submissions, I have a step-by-step process available. Send me a message to discuss what's happening in your office.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

After rebranding my company and going solo without a business partner, I discovered I needed to get intentional about how I showed up, leading to 10x growth for Fortune Billing Solutions in just one year.

• Tracked every minute of my day for two weeks to discover I was creating chaos for myself and my team
• Implemented structured timeblocking for client meetings, discovery calls, team one-on-ones, podcast recording, and CEO strategy
• Created a daily "miracle hour" focused on follow-ups, marketing, outreach and business development
• Organized my week using theme days: Mondays for admin, Tuesdays for client strategy, Wednesdays for creative work, Thursdays for business development, and "Follow-up Fridays"
• Turned off all notifications during deep work hours with only my daughter as a VIP contact
• End each day with a shutdown routine to check accomplishments and set tomorrow's priorities
• Dental billing insight: High patient AR often stems from improper co-pay calculations upfront and improper adjustments on the backend
• Color-code your calendar to make patterns visible: blue for client work, green for business development, yellow for admin, red for distractions

Book a free billing audit with us. We'd love to help you find the billing opportunities hiding in plain sight.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

A powerful reading of "Chapter 4: Built from Grit" from the book "I'm Just the Biller" shares the journey from humble beginnings to nationwide success in dental billing education. This authentic narrative speaks directly to the unsung heroes of dental practices, reminding listeners that success isn't about where you start but the invisible grit that carries you forward.

• Started career while dealing with a workplace bully who undermined confidence and flaunted material possessions
• Worked two jobs simultaneously as a dental biller and ER tech to save for first home
• First workshop in 2011 had just nine attendees who paid $19 each
• Evolved from Craigslist marketing to hosting 156 people at the JW Marriott in Los Angeles
• Experienced a full-circle moment when former bully became part of an office requiring billing consultation
• Built a nationwide platform over a decade of dedicated work in dental coding and billing education
• Recognizes that setbacks, disappointments and closed doors ultimately contributed to growth and resilience

Share this episode with your co-worker, office bestie, or that teammate who needs to hear they're just getting started. Follow the show, leave a review, and connect on Instagram @dentalbillingcoach for behind-the-scenes content, billing tips, and support for the people holding the dental profession together.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

Artificial intelligence has quietly revolutionized how dental insurance claims are processed, and most dental offices don't even realize it. Today we pull back the curtain on Novo Dynamics and their Novo Health Dental AI system that's scrutinizing your x-rays, documentation, and billing patterns before a human reviewer ever sees your claim.

The game has changed dramatically. Insurance companies have trained AI systems to review claims using very specific criteria determined by their own dental consultants—not treating clinicians. These systems don't just look at individual claims but cross-check x-rays across multiple insurance carriers, analyze your practice's billing patterns, and compare you to other providers in your area. If your practice performs more crowns, SRPs, or implants than what AI considers "average," all your claims face increased scrutiny regardless of their legitimacy.

This technological shift demands we evolve from merely submitting "clean claims" to creating "AI-proof claims." High-quality, clear x-rays that perfectly demonstrate necessity, concise standardized narratives, and meticulous documentation are no longer optional—they're essential. When AI improperly denies claims, request human review promptly. Document patterns of improper denials and report systematic issues to your insurance commissioner. The days of assuming a person will review your claim are over, but by understanding how these systems work, you can adapt your strategies to overcome these new barriers to reimbursement.

Ready to level up your billing skills and connect with fellow dental billers? Join us for our upcoming live workshop in Dallas! Send "Dallas" in a direct message to @dental_billing_coach on Instagram for your chance to win an all-expenses-paid trip to the event. Looking forward to diving deeper into AI and dental billing in our next episode where we'll share real-world denial stories and more strategies to beat the algorithms at their own game.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

Dental billing has undergone a dramatic transformation since the carefree days of the late 1990s. What was once a straightforward process—send a claim, get paid, move on—has evolved into a complex system demanding meticulous attention to detail and strict compliance measures. The reason? Insurance companies have woken up to the staggering $12.5 billion lost annually to dental fraud, and they're scrutinizing claims like never before.

You don't need to be committing actual fraud to get caught in this web. Cutting corners, skipping steps, and clinging to outdated "backyard billing" habits can quickly put a target on your practice. Are you submitting claims without checking clinical notes? Skipping attachments to get claims out faster? Using coding loopholes that worked a decade ago? These practices aren't just inefficient—they're potentially putting your practice at risk for denials, audits, and recoupment demands.

True billing expertise isn't defined by years of experience but by commitment to compliance and continuous education. It means verifying clinical documentation matches what you're billing, understanding dental necessity requirements, staying current with coding changes, and implementing robust follow-up systems. It means knowing when to push back when insurance companies request additional information despite receiving sufficient evidence the first time. Most importantly, it means understanding your state's prompt pay laws and holding insurance companies accountable when they attempt to delay payment beyond legal timeframes.

The transition from backyard billing to compliant billing isn't complicated, but it requires intentionality. Start by implementing daily report monitoring, creating standardized billing protocols, and ensuring your team understands compliance requirements. The reward? Fewer denials, faster reimbursements, and significantly less stress from chasing payments that should have been received the first time. Remember: the goal isn't just getting claims paid—it's getting them done right.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

Uncover the critical connections between HIPAA compliance and dental billing practices in our episode featuring host Ericka Aguilar. Discover how safeguarding patient privacy extends beyond ethical boundaries to play a pivotal role in averting billing fraud in dental practices. We delve into the cutting-edge strategies employed by insurance companies, such as predictive analytics, to detect inconsistencies and initiate audits without relying on whistleblowers. Erika sheds light on the risks associated with common pitfalls like inappropriate code adjustments and the negligent waiving of co-payments that insurers might interpret as fraudulent activity. By gaining a deeper understanding of insurance audits and adhering strictly to HIPAA's privacy, breach, and anti-kickback policies, dental professionals can uphold their practice's integrity and maintain the trust of insurance companies.

Explore the heightened scrutiny dental offices face due to the rise of AI in insurance auditing, as Ericka highlights the dire consequences of billing inaccuracies, including high denial rates and the ominous threat of clawbacks. With the potential for significant financial repercussions, she emphasizes the importance of accurate billing and the dangers of fraudulent resubmissions. Learn how diligent denial tracking and effective appeals can be your defense against unnecessary audits and penalties. Hear practical advice on how to navigate the complexities of maintaining compliance, including when to involve the insurance commissioner to protect your practice from potential pitfalls and maintain ethical billing standards.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

Tired of bureaucratic inefficiencies and missed technological opportunities? Join us as we analyze the healthcare workforce, dissecting the tough reality of supply and demand in medical residencies, with a special focus on the rising field of pediatric dentistry. We'll reflect on personal encounters with government red tape and ponder how the tech boom of the 90s could have spurred a much-needed modernization of government systems. We'll even speculate on how influential figures like Bill Gates and Elon Musk could have further propelled these advancements.

Thinking about launching your dental career in an underserved area? Discover strategic insights on how to capitalize on dental care shortages by using data to pinpoint opportunities, and learn how buying out retiring dentists can set the stage for a prosperous practice. We also debate whether specialization in high-demand services like endodontics requires extensive schooling or if ambition and a good attitude can suffice. Expect candid discussions on the importance of self-care and reassessing your career path to ensure it brings you joy, much like evaluating the health of your personal relationships.

As technology continues to transform industries, we'll highlight why it's crucial to keep your skills sharp, whatever your field of expertise. From the evolution of dental billing practices and the indispensable role of consultants to the need for continuous education in today's rapidly changing world, our conversation covers it all. Enjoy a light-hearted wrap-up as we share personal family anecdotes that remind us of the importance of gratitude and the fun quirks of familial bonds. Prepare for an engaging episode that combines professional insights with personal charm.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Got questions? Send Ericka a Text!

Legendary dental expert and Founder of Dental Town Howard Farran joins me, Ericka Aguilar, for a compelling exploration of the future of dentistry, challenging the conventional norms that govern the industry. We embark on a fascinating journey through Howard's personal story, from Kansas to Arizona, navigating the complex economic barriers and education demands that define the profession. Together, we unravel the financial intricacies of being a dentist, contrasting the roles of general practitioners, specialists, and practice owners while scrutinizing the implications of operating within a cartel system.

The digital age is upon us, and AI is set to redefine the landscape of dental practices. We dissect the inefficiencies plaguing current practice management software and uncover how AI innovations, like the pioneering dental AI chatbot, promise to streamline operations and unlock new levels of efficiency. Drawing from a wealth of experience, the conversation paints a vivid picture of how AI can transform the way dental practices operate, enhancing both user experience and operational effectiveness, setting a new benchmark for the industry.

As we navigate the evolving business dynamics and global challenges in dentistry, the conversation broadens to encompass healthcare access in America. We shine a light on the disparities in dental and women's health services, particularly in rural areas, and consider the potential of international specialists to bridge these gaps. Our discussion also highlights the pivotal role of Dental Service Organizations in capital formation and their strategic influence in the market. Through it all, we stress the importance of ensuring quality and integrity by having industry-specific professionals at the helm, safeguarding the core values of dentistry amid shifting economic and regulatory environments.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
[email protected]

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)