AR and Collections: How to Collect the Money You Already Made

Direct answer: collect 98% or more of adjusted production, keep AR over 90 days below 15% of total AR, and submit clean claims within 24 hours of the appointment. The money you lose in collections is pure margin — there's no lab bill, no chair time, no supply cost attached to it. Planet DDS calculated that closing the average operational billing gap adds roughly $890,000 in annual EBITDA to a practice group doing $10M in gross production, with no new patients required.

By Pete Volk, Dental Strategy Institute

Production is what you did. Collections is what you got paid for. The gap between them is the least glamorous number in dentistry and the most expensive one to ignore.

I've watched owners spend $60,000 on a marketing campaign to grow production 8% while carrying $140,000 in aged receivables they'd mentally written off. It's not irrational, exactly. Marketing feels like building. Chasing money feels like admitting something went wrong. But one of those has a cost of acquisition and the other one is already yours.

The Two Benchmarks

The ADA is direct about this: if a practice isn't collecting 98% of billable, adjusted production, the policies and scripts need adjusting.

Adjusted production, not gross. Contractual write-offs come out first. What's left is what you agreed to accept, and you should be getting nearly all of it.

The second number is AR aging. What percentage of your total receivables is over 90 days old? Under 15% is healthy. Over 25% and money is actively evaporating, because collectability drops sharply with age — a receivable at 120 days is worth a fraction of the same balance at 30.

Both numbers are easy to pull and most owners look at them twice a year, in a panic, usually after their CPA asks a question.

What This Is Worth

The Planet DDS 2026 Dental Industry Outlook: Deep Dive — 8,500+ practices, 497 DSOs, $6.79 billion in gross production — named revenue cycle efficiency the "silent EBITDA lever." Their language, and it's the right frame.

Their math: for a group generating $10M in gross production, closing the average operational billing gap adds approximately $890,000 in annual EBITDA. No new patients. No new providers. No new locations.

Scale it down to a solo practice doing $1.2M and you're talking roughly $100,000 in recoverable margin. That's not a rounding error. In most practices that's the difference between a good year and a great one, and it costs you a systems change rather than a capital investment.

Worth remembering why this matters more now. ADA Health Policy Institute data shows that since January 2021, your equipment and supply costs are up 23% and staff wages up 23%, while reimbursement across all payer types rose just 19%. When the top line is squeezed, the leaks matter more.

The Insurance Side: Claims Discipline

Most AR problems are claim problems wearing a patient-balance costume.

Submit within 24 hours. Every day a claim sits unsubmitted is a day added to your AR clock, and it compounds — the practice that submits weekly has a structurally worse AR profile than one that submits daily, even with identical payers. Batch submission is a habit from the paper era. There's no reason for it now.

Attach everything the first time. Perio charting, radiographs, narratives for anything that historically gets questioned. A claim that comes back requesting documentation costs you 30 days minimum, and the second submission goes to the bottom of the queue.

Work the aging report on a schedule, not on a feeling. Every claim hits 30 days without payment, someone calls. Not emails through the portal — calls, gets a reference number, and documents who they spoke to and what was said. Payers respond to documented follow-up in a way they don't respond to resubmission.

Track denials by reason and by payer. This is the step almost nobody does, and it's where the pattern lives. If 40% of your denials are one payer citing one thing, you have a fixable coding or documentation issue, not a collections issue. Fix the upstream cause and the AR fixes itself.

Verify benefits before the appointment, in writing. Not "we called and they said." A documented breakdown with a reference number. When a patient's estimate is wrong by $600 because nobody checked the frequency limitation, that balance becomes very hard to collect and the patient is right to be annoyed.

The Patient Side: Ethical and Effective

My rule on patient collections: the conversation you have before treatment determines how hard the conversation after treatment will be.

Practices with collections problems almost always have estimate problems. The patient was told "insurance should cover most of it," insurance covered 40%, and now they've got a $900 bill they didn't expect and a feeling that they were misled. Whether or not you meant to mislead them is irrelevant to how they experience it.

So the fix starts before the drill.

Written estimates, always. Show the fee, the expected insurance portion, and the patient portion. Say out loud that it's an estimate and the final number can shift. Have them sign it. This takes ninety seconds and eliminates the majority of downstream disputes.

Collect the patient portion at time of service. Not "we'll bill you." Once a balance leaves the building it gets exponentially harder to collect, and you've just converted a payment into a receivable at your own expense.

Have financing sorted before treatment, not after. At least one third-party option with a real approval path. A patient who's approved for financing before the appointment shows up ready. A patient who gets handed a brochure at checkout goes home to think about it.

Make it easy to pay. Card on file with written authorization, text-to-pay, online portal. Every point of friction is a reason to put it off, and putting it off is how a 30-day balance becomes a 120-day balance.

When It's Already Late

For balances that got away, the approach that works is early, warm, and specific.

The first contact at 30 days should be a phone call, not a letter, and it should sound like customer service rather than debt collection. "Hi Marcus, it's Karen at Dr. Miller's office. Your insurance paid a little less than we estimated on the crown, so there's a balance of $312. I wanted to call rather than just send a statement — can we take care of that today, or would a payment plan work better?"

That call resolves a lot of balances, because most people aren't refusing to pay. They opened a statement, felt confused or annoyed, put it on the counter, and forgot.

Escalate on a defined timeline. Call at 30, statement plus call at 60, written notice at 90 explaining next steps, decision at 120 on whether to send to collections or write off. Write it down as a policy and follow it, because inconsistent enforcement is worse than no policy — your team learns it's optional and your patients learn who can wait you out.

Two ethical guardrails I'd hold firm on. Never discuss a balance where other patients can hear it — that's a dignity issue and in some framings a privacy issue. And never withhold emergency care over a balance. Elective treatment, reasonable to hold. Someone in pain, you see them and sort the money after. That's not just decency; a practice that gets a reputation for the other thing has a much bigger problem than $400.

Who Owns This

One person, with a job description that says so, and time blocked to do it.

The most common failure I see is that AR follow-up is assigned to whoever has a free moment, which means it happens when the schedule is light and never when it's busy. Block two hours, twice a week, on the calendar. Protected time. That's the entire fix in a lot of practices.

Then report on it. Monthly: collections rate, AR aging by bucket, denial rate, days in AR. Take five minutes at the team meeting. When the front desk sees collections rate move from 94% to 97% and understands they did that, the behavior sticks in a way that no policy memo achieves.

The Part Nobody Mentions

Clean AR shows up when you sell.

A buyer or DSO looking at your practice reads AR aging as a proxy for operational discipline. Aged receivables get discounted heavily in a valuation, sometimes to zero past 120 days, and a bloated AR balance raises questions about everything else — are the collections numbers real, is the production number real, what else isn't being managed?

Owners spend three years before a sale trying to grow production and ignore the receivables that are dragging the multiple. Cleaning up AR is faster, cheaper, and it flows straight to EBITDA, which is the number the buyer is actually multiplying.

Collect the money you already made. It's the highest-margin work in the practice and nobody has to say yes to anything.

Related Reading

• Dental AR Days and Collections Rate: What the Benchmark Data Says and How to Fix Both
• What EBITDA Actually Means in a Dental Practice — and Why Your Tax Return Doesn't Show It
• What Is a Good PPO Write-Off Rate? Dental Benchmark Data and the Drop-Plan Analysis
• Dental Practice Exit Strategy: What to Do in the 3 Years Before You Sell
• What Should Dental Practice Overhead Be? Benchmark Data Across All Six Cost Categories

Get your free Practice Health Score.

Enter your numbers once. Get a percentile scorecard across 10 metrics — production, collections, staffing, patient economics, and overhead — benchmarked against real peer practices.

Run Your Free Practice Health Scorecard →

Takes under 5 minutes. No credit card. Your data is never shared.