Dental insurance revenue leakage happens when completed treatment doesn’t turn into collected revenue. A claim sits without follow-up, a procedure gets left off a submission, or secondary insurance is missed. Each issue may seem small, but together they can leave a surprising amount of money uncollected.

Before putting more money into marketing or trying to increase production, take a closer look at what the practice has already earned.

Start With the Insurance Aging Report

Pull the insurance aging report from Open Dental, Dentrix, Eaglesoft, or the practice’s billing software. Sort it by age and payer, then look closely at every balance older than 60 days.

The amount sitting in the 90-day-plus column will depend on monthly production, PPO mix, and payer turnaround times. Even so, that balance shouldn’t keep growing without a clear reason.

For claims older than 90 days, call the payer before submitting the claim again. Confirm its status, document the representative and reference number, then record the next action and follow-up date.

It also helps to have one team member review the 60-day-plus column every Monday. That person doesn’t need to own the entire billing process. The goal is simply to make sure every older claim has a status and a next step.

Treat the aging report like a weekly work list. It becomes much more useful when it guides action instead of sitting in a folder. If the team isn’t confident in navigating this report in your software, the Open Dental training resources at DSN cover how to pull and interpret these reports accurately.

Take Another Look at PPO Fee Schedules

Many practices review PPO fees during credentialing and don’t revisit them for several years. During that time, the practice may continue accepting reimbursement based on an outdated fee schedule.

Start with the 20 procedure codes completed most often. Compare the full office fee, contracted PPO fee, monthly volume, and estimated adjustment for each code.

For example, if the office fee for D2740 is $1,350 and the contracted rate is $950, the practice adjusts off $400 for each crown completed under that plan. At 15 crowns per month, that difference could reach $6,000, depending on how many of those patients carry the plan.

Use this review to identify which payer contracts deserve attention first. Fee increases aren’t guaranteed, and the result may depend on the local market, provider availability, participation history, and the number of patients covered by the plan.

This doesn’t mean every PPO should be dropped. It means the owner should understand the agreement and its financial impact before treating every write-off as unavoidable. For owners who want a broader framework for tracking these financial levers alongside other practice metrics, the dental practice management resources at DSN are a practical place to start.

Catch Dental Insurance Revenue Leakage Before the Claim Goes Out

Many insurance problems begin before the billing coordinator receives the claim. Missing procedures, incomplete notes, and unclear checkout responsibilities can create errors that don’t become visible until weeks later.

Focus on these three common gaps:

• Unscheduled treatment: Pull the unscheduled treatment report each week, sort it by dollar value, and give the treatment coordinator a manageable follow-up list.
• Incomplete claims: Have the clinical team compare completed procedures, notes, images, and narratives with the schedule before leaving each day.
• Missed secondary insurance: Confirm secondary coverage during checkout and review it again when the primary explanation of benefits arrives.

When several team members schedule treatment, post payments, or submit claims, it’s easy for a step to get missed. A clear process for front-office scheduling and billing can help the team understand who owns each task and when the work should be checked.

Keep the End-of-Day Review Simple

A checklist won’t help if it’s too long to use on a busy afternoon. Keep the review focused on the few items most likely to affect claim accuracy and collections.

Before the front office closes, confirm that completed procedures match the schedule, required documentation is available, payments are posted correctly, and every unresolved item has an owner.

The office manager can also spot-check three to five claims each week. Compare each claim with the clinical notes, attachments, and ledger entries to catch issues before they turn into older balances. For office managers who want to build more consistent daily oversight habits, the daily operations guidance for office managers covers how to structure these reviews without adding significant time to an already full day.

This review may only take 10 minutes. That’s often enough time to catch a missing crown, an unposted EFT, or a claim waiting for an attachment.

Make Insurance Follow-Up Easier for the Team

Insurance calls are easier to complete when the team has a simple script to follow. A 60- or 90-day claim call can begin with:

“Hi, this is [name] from [practice name]. I’m following up on a claim submitted on [date] for [patient name], claim number [number]. Can you confirm the claim’s current status and whether anything else is needed?”

After the call, document the representative’s name, reference number, claim status, requested action, and follow-up date. A note that only says “called insurance” won’t help the next person understand what happened.

Written procedures are especially helpful during staffing changes. Without consistent training for new front-office team members, every new hire may learn a slightly different way to submit claims, post payments, and document follow-up, which creates gaps that show up in the aging report months later.

Is It a Production Problem or a Collections Problem?

These problems can feel similar because both affect the bank balance, but they require different solutions.

A collections problem may show up as stable production with falling collections, growing insurance aging, repeated denials, or rising write-offs. A production problem is more likely when collection performance remains healthy, but open chair time, lower case acceptance, or a change in procedure mix reduces total revenue.

Review adjusted production, net collections, insurance aging, write-offs, case acceptance, and open chair time together. PPO participation and software settings can affect the numbers, so use the same definitions and reports each month.

If production remains at $120,000 per month while the collection rate falls, adding more patients may create more claims without addressing the reason revenue isn’t being collected.

Start With What the Practice Has Already Earned

Pull the insurance aging report and sort it by age and balance. Give every claim older than 60 days a status, a next action, an owner, and a follow-up date.

That one review can help show whether the practice needs better claim follow-up, clearer documentation, updated fee schedules, or additional front-office training. If the team needs structured support building these habits, DSN’s membership community connects practice owners with peers who have already worked through the same billing and collections challenges.

Frequently Asked Questions

What is a healthy collection rate for a dental practice? Many practices aim to collect at least 95% of adjusted production, with stronger-performing offices often targeting the upper 90% range. PPO mix, payment timing, financing arrangements, and software settings can affect the result, so calculate it the same way each month.

How often should PPO fee schedules be reviewed? Review major PPO fee schedules at least once a year and whenever a contract changes. Start with the plans covering the largest share of active patients, then compare their allowed fees across the practice’s highest-volume procedure codes.

What commonly causes dental insurance claim denials? Missing attachments, incomplete narratives, incorrect patient information, coverage limitations, coding errors, and late submissions are common causes. Track denial reasons by payer and procedure code to see which problems continue to repeat.

Who should own insurance follow-up? Assign one person to maintain the insurance aging work list, even if several team members help make calls or submit corrections. The office manager or billing lead can review progress each week and help with claims that continue aging without a clear next step.

When would formal insurance training help? Training may help when the same denials keep appearing, the aging report continues to grow, or new hires receive different instructions from different team members. Building a consistent process for front-office billing and insurance follow-up gives the whole team a shared standard to work from, regardless of who handles a given task on a given day.