The Dental Billing Podcast

Ericka Aguilar
  • 4.6 (25)
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  • Updated Weekly

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. 1d ago

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

    Send us Fan Mail 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. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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. 3d ago

    How Membership Plans Help Dentists Drop PPOs

    Send us Fan Mail 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. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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. 6d ago

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

    Send us Fan Mail 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. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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 4

    What If We Called the Denial What it Really is: A Business Model Designed to Delay Payment

    Send us Fan Mail Less than 1% of denials get appealed in the real world, yet regulators have found appeal reversal rates that should stop every dental office in its tracks. We pull apart what that contradiction tells us: denials are not just “one-off mistakes,” they can be a business model that survives on provider exhaustion, unclear standards, and paperwork loops that quietly delay payment until you give up. We walk through the hidden source material most billers never read market conduct examinations, consent orders, and enforcement actions where the state audits the insurance carrier and publishes what it finds. From “sequential” documentation requests to denial language that fails to explain what would make a claim payable, these reports turn gut feelings into quotable evidence. We also explain why a fine is effectively a written confession: it shows which behavior could not survive an audit and gives you leverage to reverse engineer your next appeal and escalation. Then we get practical. Clean claim is a legal term tied to prompt pay law, and understanding it changes how you respond to additional information requests designed to stop the clock. We share two calm questions you can use immediately: ask for the filed policy provision that supports the denial, and ask which licensed clinician reviewed the claim and whether they reviewed the submitted documentation. Finally, we zoom out to pattern recognition: denial rates, overturn rates, time-to-payment, and filing complaints with the right regulator based on plan type, including ERISA self-funded plans and the US Department of Labor. If you want smarter dental billing appeals and stronger denial management, listen now, subscribe for more, and share this with a biller who is tired of water-gun tactics. What denial pattern are you seeing most in your office? Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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. Jul 22

    Adjustment Slop: The Money Leak Nobody's Looking At

    Send us Fan Mail A huge amount of dental practice revenue doesn’t disappear because patients refuse to pay or because insurance “just won’t cover it.” It disappears because someone clicks an adjustment code and the money evaporates without a clear name, a written policy, or a second look. That quiet leak is what I call adjustment slop, and once you learn to spot it, you won’t be able to unsee it. We start by separating two concepts that too many offices blur together: write offs versus adjustments. Write offs are contractual and tied to your PPO fee schedule. Adjustments are choices, like courtesy discounts, employee perks, hardship cases, marketing promos, or quick “fixes” that make an awkward balance go away. When everything gets dumped into one generic bucket, you lose the story your data is trying to tell. You can’t manage what you can’t see, and you definitely can’t make smart decisions about participation, profitability, or team habits. Then I walk you through the five types of adjustment slop I see when I take billing departments apart: habit adjustments, cover up adjustments that bury unworked claims, lazy courtesy with no authority, “corrections” that hide posting errors, and bad debt adjustments that happen before real collection steps. You’ll also get my teardown method you can do tonight: pull a 12 month adjustment report, sort by type, and ask one yes or no question for each label: is there a written policy behind this? If you want your billing reports to be real management tools, not financial guesswork, hit play, pull your report, and start labeling money with intention. Subscribe, share this with your office manager, and leave a review if it helps you stop the leak. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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. Jul 14

    Built to Get Paid Series - Part 6 - Denial Management & Escalation that Works

    Send us Fan Mail Less than 1% of denied dental claims ever get appealed and insurance companies are counting on you to be in the other 99%. I walk you through the denial management mindset shift that changes everything: stop treating the third appeal like the edge of the map and start using the tools that actually hold payers accountable, including your state insurance commissioner for fully insured plans.  We get practical and specific about what makes a denial “unreasonable” or “bad faith” and how to spot the pattern: benefits are active, eligibility is confirmed, documentation supports dental necessity, and the claim still comes back denied. I also explain why we start with state and federal laws before we obsess over codes, because language like prompt pay, network leasing, and silent PPO issues gives your conversations more weight. Then we clean up common risk areas by separating an honest mistake, a contract violation, and fraud, because mixing those up can put a practice in real trouble.  From there, we talk tactics: why copy-and-paste appeal templates can work against you in a world where insurers use AI to review claims, and what to use instead. Think ICD-10 diagnosis codes, strong narratives, and patient-specific clinical details that make your claim defensible. Finally, I share documented enforcement examples, including a major fine tied to undisclosed “phantom” frequency limits, and why complaints to regulators compound over time.  If you want a denial process that protects patients and stops leaving money on the table, listen all the way through, then subscribe, share this with your office team, and leave a review so more billers learn how to escalate the right way. Sources referenced in this episode: Appeal rate / upheld rate: KFF analysis of CMS data — fewer than 1% of denied ACA marketplace claims are appealed; insurers uphold ~56% of appeals (2023 data), 66% (2024 data). Medicare Advantage: ~57% of appealed denials overturned. (On air we used these instead of the "59% upheld because nobody appealed" framing, which conflated the appeal rate with the uphold-on-appeal rate.)Delta Dental of Washington: Washington State Office of the Insurance Commissioner fined Delta Dental + its health care benefits manager (Wyssta) $130,000 (Oct/Nov 2024) for, among other things, denying claims based on time/frequency limits not filed with or approved by the state; 7 service types and 50 billing codes had undisclosed limits. Triggered by consumer complaints. This is an actual regulatory fine.Self-funded vs. fully insured (the "federal path" mention): The commissioner regulates fully insured plans. Self-funded employer plans fall under federal ERISA law and route to the U.S. Department of Labor (EBSA) instead, not the state commissioner. This is covered in depth in the full denial management talk, not this episode. (Government and church plans are a further exception.)Cigna PxDx: 2023 class action (E.D. Cal.), citing ProPublica reporting — ~300,000 denials in two months, avg. 1.2 seconds per claim, "we literally click and submit." Court allowed the case to proceed March 2025 (abuse of discretion). This is litigation, not a fine — described on air as a lawsuit/court ruling.UnitedHealth nH Predict: Class action (D. Minn.) alleging a 90% error rate on the AI tool and that ~0.2% of policyholders appeal. Court ordered algorithm disclosure in 2026. Allegations in active litigation — stated as such on air.The "0.2% will appeal" motive appears in both the Cigna and UnitedHealth complaints as an allegation of intent. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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. Jul 13

    Dental Billers Appreciation Day

    Send us Fan Mail Dental billing can look smooth from the outside, but that “smooth” is usually one person doing a mountain of detailed, high-stakes work behind the scenes. We’re sharing a quick, focused message about Dental Billers Appreciation Day and why it matters for every practice that depends on clean claims, accurate coding, and steady collections.  You’ll hear how a conversation with Qiana Craig (Ask the Biller) about Medical Billers Appreciation Day sent us down a research rabbit hole and revealed something surprising: dental billers didn’t have a day of their own. So we created one. That story opens up a bigger theme we live by in dental office administration and practice management, if you don’t see the space you need, build it.  We also get real about what the job requires: deep organisation, constant follow-up, tech skills across modern billing tools, and the discipline to keep up with changing codes and systems in today’s dental economy. Dental revenue cycle management doesn’t run on luck, it runs on expertise. Dental Billers Appreciation Day is July 20 every year, so mark your calendar and do something meaningful for the person who helps keep your practice financially healthy. If this resonates, subscribe, share it with your team, and leave a review so more dental offices start giving billers the credit they’ve earned. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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. Jul 7

    Built to Get Paid Series - Part 5 of 6 - The 3 Metrics That Never Lie

    Send us Fan Mail Your insurance AR report is trying to tell you the truth, but most of us only glance at the total and walk away with more anxiety than clarity. I’m Erica Aguilar, and I’m breaking down how to read the story behind the numbers so you can tell, with real confidence, whether your dental billing department is performing well or quietly leaking time and money. We start with the biggest mindset shift: dollars alone don’t equal performance. I’ll show you how to turn each insurance AR aging bucket into a percentage so you can compare month over month and spot patterns that individual claims can’t reveal. You’ll get clear dental billing KPIs and benchmarks, including what “healthy” looks like when 92% of your insurance money is paid within 30 days, and why a heavy 90+ day category should trigger curiosity, not panic. From there, we talk through the questions that uncover root causes like late claims, missing attachments, delayed clinical documentation, weak claim construction, and payers that keep pushing you past state prompt pay laws. We also widen the lens beyond insurance AR. I explain why patient AR tells a different story, why the credit balance report can expose compliance issues and unclaimed property risk, how to trend denials by payer and CDT code, and how poor fee schedule maintenance can inflate write-offs and create bad patient balances. Then we get practical with the claims correction list, the simple tool that creates visibility where most practices have none. If you want a concrete next step, I give you homework to pull your key reports, start tracking denial reasons, and implement the free claims correction list from the show notes. Subscribe, share this with your office manager or biller, and leave a review with one question you want your reports to answer next. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist 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
    122
  • Rating
    Explicit
  • Copyright
    © 2026 The Dental Billing Podcast
  • Show Website
    The Dental Billing Podcast

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