The Dental Billing Podcast

Ericka Aguilar
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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.

  1. 6d ago

    Stop Treating Patient Credits Like Free Money

    Credit balances look harmless on a ledger, but they represent money we owe to patients or payers and they can turn into a major risk if we ignore them. We break down how to audit credits correctly, avoid accidental giveaways, and stay compliant with refund rules and unclaimed property laws. • Defining a credit balance as a liability rather than revenue  • Separating the credit balance report from accounts receivable for a true picture of risk  • Auditing one account step by step using the family ledger, the first negative transaction, and EOB comparisons  • Why we never refund directly from the report without verifying the cause  • The six common credit types and the correct action for each  • Handling Medicaid and Medicare overpayments with urgency and documentation  • Managing prepayments and deposits by linking them to treatment plans  • Using due diligence letters, dormancy rules and state reporting for unclaimed property  • Reducing audit risk and preventing practice sale delays with clean records  • Building a monthly workflow, assigning ownership and tracking ageing and totals  Share this one with your office manager and your CPA & always seek legal advice regarding your states laws regarding unclaimed property and credit management. Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

  2. Sep 15

    When AI Denies Your Claim with Dr. Amberena Fairlee

    Most dentists know the insurance system is broken. Far fewer know what it actually takes to change it. Dr. Amberena Fairlee does, because she has been in the room in Salem and in Washington DC doing it. Jen sits down with Dr. Fairlee, a general dentist in Bend, Oregon, owner of Cascadia Family Dental, and the current president of the Oregon Dental Association, for a conversation about advocacy: what organized dentistry can realistically move, what it cannot, and why declining membership makes every one of those fights harder to win. If you have ever wondered whether a day away from the chair is worth it, or what your association is actually doing with your dues, this one answers both. In this episode: Why insurance is a coupon book and not a benefit, and how to explain that to patients without losing themHealthcare requires a diagnosis: the verbiage Dr. Fairlee gives her team when patients push back on exams and x-raysWhy membership is the lever, and why quitting the association because you have not seen change yet makes change less likelyWhat insurance reform legislation actually looks like: small incremental wins and closing loopholes, not raising annual maximums by decreeERISA self funded plans claiming they do not have to follow state insurance regulation, and why that is a focus in DCAI in claim adjudication: requiring disclosure when AI denies a claim, requiring human review without an appeal, and the patient privacy questions nobody has answeredThe one payer behavior she would outlaw tomorrow: diagnostic and preventive care no longer counting against the annual maximumJen's wish list for the ODA agenda: diagnosis codes across the board, and an end to the appeal cycle on unreasonable denialsThe dental assistant and hygiene workforce shortage, and how staffing gaps push private practices toward being boughtWhy she gives up clinical days: advocacy makes her a more compassionate clinicianLeadership without being loud: be at the table, and someone will amplify your voiceAbout our guest Dr. Amberena Fairlee is a general dentist in Bend, Oregon and the owner of Cascadia Family Dental. She started in the profession as a dental assistant straight out of high school, earned her Bachelor of Science from Portland State and her dental degree from OHSU in 2017, and still holds an expanded dental assistant certificate from the Oregon Board of Dentistry. She is the current president of the Oregon Dental Association and the association's representative to the Oregon Board of Dentistry, including its Dental Assistant Workforce Shortage Advisory Committee. She also serves with the ADA's workforce ambassador group and an Oregon Health Authority healthcare workforce group. Dentists who want to get involved in Oregon can reach the Oregon Dental Association through its website, or contact executive director Barry Taylor, who can point you to the right place to start. Follow the practice on Instagram: @cascadiafamdental Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

  3. Sep 2

    REPLAY: Avoiding Prison with Defensive Documentation with Dr. Roy Shelburne

    A dentist, practice owner, and self-described “billing and documentation geek” sits down with us and tells a story most of dentistry never expects to hear: Dr. Roy Shelburne was convicted and went to prison after years of investigation tied to his Medicaid-heavy practice. The numbers are not the point. The system is. If you think “we didn’t mean to” protects you, this conversation will change how you look at dental billing compliance and clinical documentation. We dig into the uncomfortable legal reality behind intent to defraud, including “blind disregard,” where repeated errors without a system to find and fix them can be treated as fraud. From there, we get practical fast: what defensive documentation looks like before a claim is ever sent, why diagnosis must come before treatment, and how dentistry is inching toward more diagnosis-driven workflows (think ICD-10, not just CDT codes). Perio examples make it crystal clear: if the record doesn’t state the diagnosis, your SRP and inflammation-based codes are standing on thin ice. We also talk audit triggers you can prevent today: crown claims with no justification in the chart, radiographs that are not diagnostic, and documentation gaps created when notes get entered later or copied from rigid templates. Dr. Shelburne shares how to delegate documentation safely with flexible templates, how to track non-diagnostic radiographs to improve training, and how to stop “billing to benefit” so your treatment aligns with standard of care. We close with appeal strategies, payer criteria, and the mindset that helps you get paid what you are legitimately owed while lowering risk. If you want fewer denials, fewer clawbacks, and more peace of mind, listen, share this with your team, and then subscribe and leave a review so more practices build safer systems. Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

  4. Aug 25

    Protocol Vs Standard Of Care In Dental X Rays with Jen Lyman, RDH

    Someone on the internet said it’s “no longer protocol” to take x-rays at recall, and that one word is where the real danger starts. Radiographs are not a habit we do on a timer. They’re part of a provider’s standard of care, and that standard of care is a clinical decision the treating doctor owns, documents, and can defend. We walk through the practical difference between protocol and standard of care, then get specific about what the ADA and FDA patient selection guidance actually says (and what it does not say). We talk ALARA, why fixed schedules can be just as problematic as blanket “never” rules, and why the order matters every time: clinical decision first, money second. If you’re seeing more payer pushback and “clinical justification” requests, this conversation gives you language that protects both patients and the practice. Then we get into the part billers and office managers can use immediately: what not to write in the chart or claim remarks, how fraud vs abuse is evaluated, and how an undocumented service can look identical to an unnecessary one during an audit. You’ll hear ready-to-copy narrative examples that include indication, findings, diagnosis, and disposition, plus a clear explanation of diagnosis coding, ICD-10, and how the ADA dental claim form fields (including diagnosis pointers) help a payer understand the story of the tooth. If you want fewer denials and stronger appeals without letting insurance steer treatment, press play, share it with your clinical team, and bring your ugliest examples. Subscribe, share with a teammate, and leave a review so more dental billers can find this and document with confidence. Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

  5. Aug 23

    Ericka Aguilar Gets Interviewed (Finally)

    A lot of dental billing advice online is loud, confident, and wrong and the cost shows up months later as denials, write-offs, and clawbacks. So we flipped the mic and let you meet Erica, the person behind years of dental billing education, revenue cycle management consulting, and a whole lot of hard-won pattern recognition from inside real practices.  We talk through her path from a “natural-born geek” who literally tried to steal homework, to becoming a teen mom who needed a stable career fast, to discovering that the dental front office was where she belonged. From there, she builds a billing company at 22, partners in dental practices, and eventually creates Dental Career College after seeing how hard it is to hire and train great front office teams. Along the way we dig into what offices actually asked for most: stronger verbal skills on new patient calls and real competence with dental insurance claims and billing systems like Dentrix.  Then we get practical about the issues that keep practices stuck: denial management without a standard process, confusing “we did it” with “will insurance pay,” and letting coverage rules creep into clinical decision-making. Erica shares why billers must keep up with updated CDT codes, invest in continuing education, and prepare for diagnosis codes and AI in dentistry, because the billing landscape is changing fast and it will leave people behind.  Follow us for tips and updates, and don’t miss the upcoming live webinar: bring your denials and your questions. If this helps, subscribe, share the episode with your office, and leave a review so more dental teams can find it. Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

  6. Aug 17

    Credentialing Do's and Don'ts with Jen Lyman - RDH

    The fastest way to break a dental billing system is to assume the hard part starts after treatment. We sit down with Jen Lyman, now officially my co-host, and get honest about what really determines whether your dentistry turns into clean reimbursement: credentialing setup, correct identifiers, accurate provider records, and documentation that can actually support what you code. Jen shares her path from full-time clinical hygiene to building Lyman Revenue Solutions, including the burnout and physical strain that pushed her out of the chair and into the revenue cycle world. From there, we dig into the credentialing pitfalls we see constantly, especially the Type 2 NPI issue that feels “optional” until you add an associate, open a new location, or stop practicing. We talk about how contracts tied to the wrong entity create messy fixes, compliance risk, and audit exposure that can reach years back. We also get practical about operations: why provider list cleanup and fee schedule maintenance almost never happen inside practice management software, and how a monthly “billing CEO day” can prevent denials and confusion. Then we go deeper into coding and documentation, including the debates around CDT codes like D0180 and D4346, why coding is not the same thing as coverage, and why diagnosis codes on the dental claim form are becoming non-negotiable. If you want stronger claims, fewer surprises, and a team that speaks the same language from chairside to the front desk, this is for you. Subscribe, share this with your office manager or lead hygienist, and leave a review so more dental teams can find the show and fix the problems that never should have started. Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

  7. Aug 15

    How Membership Plans Help Dentists Drop PPOs

    Insurance paperwork is eating the front office alive, reimbursements keep tightening, and expenses keep climbing, yet many practices still feel stuck on the PPO treadmill. I sit down with Jordan Comstock, founder and CEO of Boom Cloud, to talk about a strategy that gives dentists real breathing room: building an in-house patient membership program that creates recurring revenue and reduces dependence on dental insurance PPO plans over time. Jordan shares the blunt numbers driving the pressure, then walks through what a membership plan looks like when it’s treated as a serious business asset instead of a “cute” discount sheet. We talk through a practical path many offices miss: grow the membership base first, create a financial safety net, then make payer changes with confidence. Along the way we dig into surprising case acceptance data comparing cash patients, PPO patients, and membership patients, plus why predictable collections on the first or fifteenth can change how you sleep at night. We also get honest about why DIY membership plans often collapse under manual tracking, forgotten billing, annual churn, and lack of reporting and how automation, staff training, and incentives make the difference. Jordan explains how Boom Cloud uses integrations and data-driven pricing to speed up launch and help teams actually scale to hundreds of members, which can improve cash flow, resilience during downturns, and even practice valuation when it’s time to sell. If you want a clearer, less stressful way to grow profitability without begging insurers to change, listen all the way through. Subscribe, share this with a practice owner who’s fed up with PPOs, and leave a quick review with your biggest question about membership plans. Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

  8. Aug 11

    27,837 Denials. Zero Appeals, make this make sense!

    Delta Dental’s logo is everywhere in dentistry, but the numbers most practices never see are sitting in plain sight in a federal CMS dataset. We walk through the CMS Transparency in Coverage Public Use File and focus on the rarely opened tab for individual marketplace standalone dental plans. Because carriers self report claims received, denials, resubmissions, and formal appeals, the file becomes an uncomfortable mirror for both payers and the dental billing systems we run inside our offices.  Here’s what stops us: Delta Dental companies across 20 states report a 22.5% in network denial rate, higher than the broader dental market in the same file, and out of network denial rates climb even further. But the real gut punch is what CMS added for 2024: resubmitted claims. When only a small fraction of denied claims come back through the door, it suggests a huge pool of abandoned revenue sitting on aging reports, quietly turning into write offs and patient balances without a deliberate decision.  We also get precise about formal appeals: what counts, why plan documents matter, how deadlines create leverage, and why regulators only have visibility when we generate a paper trail. Then we turn it into action with a practical denial management process, simple tracking fields your team can start this week, and a challenge for practice owners to stop accepting “I need to appeal those” as the end of the conversation. Subscribe, share this with your billing team, and leave a review with one change you are making after you pull your last 90 days of Delta denials. Send us Fan Mail 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: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

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Ratings & Reviews

4.6
out of 5
25 Ratings

About

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.

Information

  • Creator
    Ericka Aguilar
  • Years Active
    2021 - 2026
  • Episodes
    127
  • Rating
    Explicit
  • Copyright
    © 2026 The Dental Billing Podcast
  • Show Website
    The Dental Billing Podcast

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