Improve Profitability through Clean Claims

With almost 11 ADA recognized dental specialties and having a burgeoning market share, the specialty dental business is here to make significant gains in the coming years as we take a cursory glance on the latest trends of the dental industry.

Listen to Ryan Arnold, Principal, Wisdom Teeth Guys as he explains the possibilities that lie ahead for Dental Specialty business and how he has paid attention on patient care,technology adoption and brand management to further sustainable practice growth for his specialty.

Dentistry's Inner Circle bg 37

Creating Sustainable Specialty Dental Businesses

Dentistry's Inner Circle Podcast

A series of podcasts from practice owners on how they navigated the change and successfully transitioned to CareStack. 

Beatrice Perez

Ishtiaq Rouf

Dana Veach

Dr. Himesh Kana, DDS

Himesh Kana

 Penny Filipe

Dental Revenue Cycle Management: Automating Fee Schedules

When Capital Tightens, Operations Matter More Than Ever

Dental AI

AI in Dentistry Isn’t About Replacing People. It’s About Removing Friction.

The Revenue Engine: Turning Work Into Profit

Reducing patient no-shows and cancellations begins by accepting that 

it’s impossible to guarantee that your patients will always keep their appointments

. Once you accept that this falls outside your control, you can pool your efforts on the aspects that are within your control, and which help reduce no-shows and cancellations.

missed appointments cause a ripple effect

 that impacts your schedules, revenues, and the effectiveness of treatments. It strikes a serious blow to your bottom line. But with that said, there are 

effective safeguards you can put in place

 to address this issue. Before we explore these safeguards, let’s examine the key reasons behind no-shows and cancellations. 

Typically, patients miss their appointments when they:

Don’t understand the importance of keeping their appointments

Misunderstand when their appointment is scheduled

Self diagnose and decide to skip their appointments

Worry about bad news and try to avoid the situation

Have a shallow relationship with the provider

There is a wide range of reasons for patients to miss their appointments, but most can be mitigated with improved patient-provider communication and by implementing the following safeguards.

It became widely accepted as a care delivery method after the 2020 pandemic, but thanks to the convenience offered to patients, 

 is here to stay. Outside the initial check-up and actual treatment, consultations and routine post-op visits can be performed remotely. The virtual interactions offer patients the opportunity to 

receive treatment in the comfort of their living room

 or office. The added benefit of leveraging teledentistry is it adds one less reason for patients to rethink or opt out of their dental appointments. 

Another approach that has gained traction is using 

 to collect vital patient information. E-forms are a key feature of modern practice management software (PMS). This feature is now used widely to stay in line with the COVID-19 safety protocols. With this new norm, practices have completely replaced the clipboard and embraced digitization. Another fact that supports this approach is that 

98% of patients who take time to fill out online forms commit to their appointments

COVID-19 has added fuel to the fire of dental anxiety among patients. The risk of exposure is a valid fear. The best way for you to 

 is with communication and education. Ensure you convey the safety protocols and measures followed at your practice to reduce the risks from COVID-19. Launching targeted email campaigns, and updating relevant information on your practice website and 

convey your commitment to patient care and safety

 and encourage patients to follow through with their appointments.

When you provide your patients with the option to make payments in advance, it reduces the instances of no-shows and benefits your collections and accounts receivable. Get paid upfront instead of having to wait for 2-3 months. Paying cash in advance leads to 

. You can provide this option during patient checkout, especially when both you and your patient agree with the importance of scheduling the next appointment.

Offering upfront payment at this stage is apt, as the patient is likelier to take action and commit to their oral health. Another way to make it easy for them to pay is by providing an 

. Make sure that you inform your patient about your prepaid payment options. Market it through your campaigns, newsletters, and phone scripts.

Reminders are an effective way to reduce patient no-shows. Plan your 

and decide on a frequency that works best for your target clientele. Start off with a postcard, followed by email and text reminders. Add a phone reminder a few days before the scheduled appointment. Ensure that you cut down on reminders once you receive confirmation from your patients. Practice management software aids you to launch, coordinate and track your recall campaigns effectively.

reward patients who keep their appointments

. The reward initiatives can include discounts or gift cards. The benefits of such an approach are twofold. You encourage your patients to follow through on your appointments and 

convey how much you value their participation

. Moreover, curating such experiences helps you retain your customers.

Sometimes, patients simply forget an appointment. Send 

 that can include a “We missed you at the practice” message. Follow this up with a phone call to encourage them to reschedule immediately.

It is crucial that your patients know the impact of your treatments on their oral health. If your patients are not invested in the outcomes of your treatment plan, it is unlikely that they will uphold their commitments. 

 before every appointment. Remind them of the benefits of the procedure and the progress they’ve made so far. 

 of the scheduled appointment and ensure that they are fully onboard. A phone reminder before the appointment will help refresh what they already know about the 

Patients skip appointments because they owe your practice money or are worried the procedure will be too expensive. When this happens, it’s time to 

. It’s important that payments never come as a surprise to the patient. This causes anxiety in the patient, especially when they expect hidden expenses from each visit. When 

 and benefits are discussed upfront and agreed upon, patient no-shows due to financial concerns can be avoided. 

 allows you to effectively educate and communicate with your patients. Automating tasks like appointment reminders or confirmation/cancellation emails, filling last-minute openings, and sending online forms and other notifications to engage patients, practices can drastically cut revenue loss and staff workload while reducing patient no-shows and cancellations.

Eliminating No-Shows and Cancellations at Dental Office

For a dental practice, revenue cycle management is the equivalent of the body’s circulatory system and the heart of a practice’s financial success. The revenue cycle incorporates data capture, claims and denials management, and the collection of payments from both patient and insurance receivables. A healthy system works in concert with industry best practices and technical solutions to optimize efficiencies, identify “leaks” and improve operational workflows. As every practice is unique, it is difficult to prescribe a “one size fits all” approach. However, there are key performance indicators, which can and should be followed to measure practice performance. There are several potential KPIs which provide valuable insight into the collection’s performance and financial health of practice including, but not limited to: Collections percentage, Production growth, Aging accounts receivable, Days sales outstanding, Adjustments percentage, and Credit balances. 

Since 2011, the dental industry has experienced a steady and upward trend in aging receivables, with the majority of balances aged greater than 90 days. The good news is that CareStack offers a solution that combines modern technology, effective processes, and industry expertise to kick start the heart and breathe life back into the revenue cycle.

Revenue Cycle Playbook for Dental Professional

Revenue Cycle Playbook for Dental Professionals

From small, solo practices to large, multi-location clinics, these case studies demonstrate the versatility and value of CareStack in improving the patient experience and driving practice . 

Fee schedules are one of those parts of a dental practice that almost never get attention when things are working, and almost never get blamed when things go wrong. But they sit underneath everything. Every estimate a patient sees, every claim that gets submitted, every write-off that gets calculated, all of it traces back to how those fee schedules were configured.

In dental revenue cycle management, that quiet dependency becomes a risk. Every PPO contract introduces hundreds of CDT codes with negotiated rates. Those values need to be translated into the system with precision, not just once, but in a way that holds up across every downstream workflow. When that process is handled manually, the problem is not just the time it takes. It is the accumulation of small inconsistencies that are almost impossible to detect early.

Inside CareStack, that impact becomes even more visible. Fee schedules are not just static inputs. They actively shape how the system behaves. The challenge is not extracting numbers from a document. The challenge is converting unstructured payer data into structured, system-ready rules inside CareStack RCM, in a way that remains consistent across every scenario the practice encounters.

Why Fee Schedule Configuration Is a Platform-Level Challenge

It is easy to think of fee schedule configuration as a one-time setup task. In practice, it behaves more like a foundation layer that everything else depends on.

When a front desk coordinator generates an estimate, they are relying on those values being correct. When a claim is calculated, the system is referencing those same values. When leadership reviews reports, those numbers are built on top of that same configuration. A single incorrect fee does not stay isolated. It quietly moves through estimates, claims, and reporting without triggering an obvious failure.

This is what makes it a platform-level challenge in dental RCM in US environments. The issue is not just that errors happen. It is that they propagate without visibility. By the time a discrepancy is noticed, it has already influenced multiple parts of the revenue cycle.

 RCM, that means fee schedules are not just configuration data. They are a system-wide dependency that directly affects financial accuracy.

Where Conventional Document Import Falls Short

Most fee schedules arrive in a format that was never designed for systems. They are built for readability. A human can glance at them and understand the structure, even if it is inconsistent. Systems cannot.

A single document might contain multiple layouts. Tables placed side by side. Sections without headers. Columns that shift between pages. Values that rely on visual alignment rather than explicit structure. For a human, this is manageable. For a system, it creates ambiguity.

Standard OCR tools can extract text, but they do not preserve relationships between elements. They cannot reliably determine which CDT code belongs to which fee, or how to interpret multiple fee columns in the same layout.

That gap between text extraction and structural understanding is where most automation approaches break. The system has data, but it does not have meaning. And without meaning, dental revenue cycle management systems cannot produce reliable configuration, especially at scale in dental RCM in US workflows.

To solve this, we did not try to improve extraction in isolation. We changed how the entire process works.

Instead of treating every document the same, we built a staged pipeline inside CareStack RCM that adapts to the document at each step. The system does not assume structure. It discovers it, validates it, and only then moves forward.

Each stage reduces uncertainty. Each step either confirms structure or refines it. Deterministic logic is always used first. AI is introduced only when the document moves beyond what rules can confidently handle.

This is what allows the system to deal with real-world variability while maintaining accuracy in dental revenue cycle management.

Before any extraction happens, the system evaluates how the document behaves. Not all fee schedules are equally dense. Some pages contain a small number of CDT codes with clear spacing. Others compress large amounts of data into tight layouts.

The system estimates code density and uses that to decide how to process the page. Dense layouts are segmented into smaller sections so that patterns become easier to interpret. Simpler layouts remain intact to preserve context.

This early decision has a compounding effect. By reducing structural ambiguity upfront, the system avoids errors that would otherwise appear in later stages, especially in dental RCM in US scenarios where document formats vary widely.

Stage 1: PDF Splitting and Layout Analysis

Each section of the document is processed independently. Azure Document Intelligence extracts structured tables where they exist, along with paragraph-level text and positional metadata.

But not every fee schedule contains clean tables. In many cases, structure is implied through spacing and alignment rather than explicit borders. When that happens, the system reconstructs table-like structures by grouping text based on position and alignment patterns.

This ensures that data is not lost simply because the document does not follow a standard format. At this stage, the goal is to capture everything that might be relevant, even if it is not yet fully structured.

Once data is captured, the system needs to make sense of it. Fee schedules often contain multiple structural variations within the same document. Columns may change. Headers may disappear. Tables may merge unexpectedly.

Normalization aligns everything into a consistent schema that CareStack RCM can use. The system first applies rule-based logic to identify patterns and standardize structures. When those rules cannot resolve ambiguity, AI is used to interpret the layout.

One of the most common issues is merged tables. A page that visually contains multiple tables may be interpreted as a single structure. The system detects this by identifying repeated CDT code patterns and attempts to split the structure using deterministic logic.

When the layout becomes too complex, AI is used to interpret the visual structure and separate the tables accurately.

Even after tables are separated, column structures may not align. Some tables may contain additional columns. Others may lack headers entirely. The system evaluates these variations and aligns them into a consistent format.

If text-based normalization is not sufficient, image-based extraction is used to reconstruct the structure more accurately. This layered approach ensures that structural variability does not translate into configuration errors.

With structure normalized, the system identifies which columns represent CDT codes and which represent fees. This is handled primarily through deterministic logic.

The system evaluates CDT code patterns, numeric density, currency formats, and header signals. Based on these inputs, it classifies each column without relying on AI.

This step resolves most cases, which is critical for maintaining predictable performance in dental RCM in US environments. The system does not default to AI. It uses it only when rules cannot confidently resolve the structure.

When rule-based detection encounters ambiguity, AI-based adjudication steps in. This is typically required in cases where multiple fee columns exist, or where headers are unclear or missing.

Instead of forcing a decision, the system evaluates the layout in context. It considers how values are positioned and how patterns repeat across the document. This allows it to interpret complex structures without introducing incorrect assumptions.

Once the structure and column roles are clear, the system extracts CDT-fee pairs and converts them into structured entities within CareStack RCM.

Each value is linked back to its source location in the document. This ensures traceability, which is important for auditing and validation. At this point, the data is no longer just extracted. It is usable, system-ready configuration within dental RCM in US workflows.

Every document processed through the system generates detailed diagnostics. This includes the sequence of steps executed, decisions made at each stage, fallback usage, and confidence levels.

This visibility is critical. It allows teams to understand not just the output, but how that output was produced. In dental revenue cycle management, where accuracy directly impacts financial outcomes, that level of transparency is essential.

As the system evolved, one issue became clear. The pipeline worked, but without visibility, it was difficult to understand why it worked in some cases and failed in others.

This led to the introduction of observability. Every stage of the pipeline is logged. Every decision is recorded. Every fallback is tracked.

Diagnostics capture key details such as code counts, table detection results, processing duration, and cost distribution across stages. Over time, this data reveals patterns. Certain carriers consistently introduce structural challenges. Certain layouts trigger specific fallbacks.

These insights allow the system to improve continuously. Observability turns the pipeline from a static process into something that evolves with real-world data.

From the beginning, the system was designed around a simple principle. Rules first. AI second. Deterministic logic provides consistency, speed, and control. AI provides flexibility when structure becomes too complex for rules alone.

A purely rule-based system cannot handle the variability of real-world documents. A fully AI-driven system introduces unpredictability and higher operational cost. The hybrid model balances both, making it practical for dental revenue cycle management inside CareStack RCM.

The goal is not to replace rules with AI, but to extend their capabilities where needed.

Embedding this workflow into CareStack changes how fee schedules are handled in practice. What was once a manual, time-consuming process becomes structured and consistent.

Insurance plan onboarding becomes faster. Manual effort is reduced. Estimate accuracy improves. Billing discrepancies become less frequent. The system behaves more predictably because the underlying configuration is more reliable.

For multi-location organizations, this removes a major operational bottleneck in dental RCM in US environments. It allows teams to scale without increasing administrative overhead or introducing additional risk.

Enabling Scalable Insurance Configuration

As practices expand their payer networks, the complexity of managing fee schedules increases. Each new contract introduces variability, and manual processes struggle to keep up.

Automated processing ensures that scaling does not introduce instability. Instead, it provides a consistent approach to handling complexity, which is essential for modern dental revenue cycle management.

Toward Intelligent Administrative Automation

Fee schedules are just one part of a broader category of payer documentation. The same approach can be extended to contracts, reimbursement policies, and plan updates.

By combining AI document processing with system-level logic, dental RCM in US workflows are moving toward intelligent automation. Systems are no longer just processing data. They are interpreting it, adapting to it, and improving over time.

Role of Fee Schedules in Dental RCM in US

Fee schedules form the foundation of billing accuracy and revenue predictability. When they are configured correctly, claims are processed more accurately, denials are reduced, and financial outcomes become more consistent.

Their role may not always be visible, but their impact is present across every stage of dental revenue cycle management.

Fee schedule configuration is not a background task. It is a foundational layer that determines how accurately a dental practice operates financially.

When that layer is misaligned, the effects spread across estimates, claims, and reporting. The approach described here addresses that challenge by combining structured document analysis, rule-based processing, selective AI augmentation, and observability.

Inside CareStack RCM, this creates a system that is not just automated, but reliable. For dental RCM practices in the US, that translates to faster onboarding, fewer errors, and stronger financial performance.

For a deeper look into the technical implementation behind this approach, including how document variability is handled at scale, you can explore our 

Looking for the best cloud-based dental software?

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After spending time this week at the JP Morgan Healthcare Growth Forum in Nashville, one message came through loud and clear:

The healthcare organizations that win over the next several years won't necessarily be the ones with the most capital. They'll be the ones with the strongest operations.

For much of the last decade, growth was fueled by abundant capital, acquisition opportunities, and favorable market conditions. Today, the environment looks very different.

As a result, healthcare leaders are being forced to answer a question many haven't had to answer in years:

How do we create growth when capital is no longer the primary catalyst?

The answer that surfaced repeatedly throughout the conference was operational excellence.

One of the operators who embodies this mindset is 

, who was gracious enough to host me during the event.

What stood out wasn't a conversation about waiting for markets to improve or hoping capital becomes more readily available.

About creating visibility into performance.

About focusing relentlessly on the operational levers that organizations can control regardless of market conditions.

That mindset appeared repeatedly throughout the conference.

The strongest operators weren't talking about external factors.

They were talking about operational excellence.

History has shown that market leaders are often built during periods of uncertainty.

Companies like Walmart didn't pull ahead because they had perfect market conditions. They pulled ahead because they continued investing in operational excellence while competitors became reactive.

Healthcare may be entering a similar moment.

In many ways, it reminded me of the old saying:

Periods of market uncertainty have a way of exposing operational weaknesses. They also create opportunities for disciplined organizations to separate themselves from the competition.

Unfortunately, many organizations respond to market shifts by looking for the safe bet.

The problem is that standing still often becomes the riskiest decision of all.

Doing the same things that worked in a different market while expecting different results rarely ends well.

One lesson that surfaced repeatedly in Nashville is that market shifts expose the difference between organizations driven by process and organizations driven by emotion.

The strongest operators rely on systems, metrics, accountability, and disciplined execution.

They allow uncertainty to influence decision-making.

In uncertain markets, process compounds while emotion creates volatility.

The organizations that emerge strongest from this cycle will likely do the opposite.

They will make decisions based on data rather than emotion.

And they will focus relentlessly on same-store growth.

Throughout the forum, conversations around same-store growth were remarkably consistent. Healthcare organizations are increasingly focused on:

Improving patient acquisition and conversion rates

Optimizing provider schedules and capacity utilization

Accelerating revenue cycle management and cash collections

Leveraging automation and AI to reduce administrative burden

Creating greater visibility into operational performance across locations

In a market where capital is constrained, these operational improvements often produce a faster return than expansion alone.

Industry answer rates across healthcare and dentistry often range between 57% and 72%. That means many organizations are missing opportunities simply because staff are helping patients in front of them when the phone rings.

Every unanswered call represents a potential new patient.

Or an existing patient who may never call back.

Leading organizations are beginning to leverage AI-powered communication platforms to ensure every call is answered, every patient receives immediate engagement, and every opportunity is captured even when staff are fully occupied delivering care.

The same trend is emerging within revenue cycle management.

Insurance eligibility verification can consume up to 45 minutes of staff time per patient. Across multi-location healthcare organizations, that translates into hundreds or even thousands of hours spent on repetitive administrative work.

Forward-thinking organizations are increasingly using automation and AI to handle these tasks, allowing team members to focus on patient care, patient experience, and higher-value activities that directly impact growth.

These aren't technology initiatives for the sake of technology.

They're operational excellence initiatives.

The organizations that emerge strongest from this cycle will not necessarily be the ones that cut the deepest.

They will be the ones that become more efficient.

The ones that use technology, automation, and AI to remove friction from the patient journey while allowing their teams to focus on the work that creates the most value for patients and the organization.

Because operational excellence is no longer just an efficiency strategy.

Eventually, access to capital will improve.

When that happens, the organizations that spent this period strengthening operations will be positioned to move faster and outperform their peers.

The healthcare landscape is entering a chapter where execution matters more than enthusiasm, process matters more than emotion, and operational excellence has become one of the most important competitive advantages a healthcare organization can build.

Thank you again to Chad Trull and the HighFive Healthcare team for the hospitality and conversations throughout the event. I also appreciated the opportunity to spend time with David Skelton from Flagship Specialty Partners and many others who are proving that great operators don't wait for better conditions, they build better systems.

Because when capital tightens, operations matter more than ever.

Why operationalizing AI, not just adopting it, will become a defining advantage for modern dental organizations.

One of the strongest conversations at the

 came from the main stage presentation by 

, co-founder of Alcan Dental Cooperative and Kids Tooth Team, who focused less on AI hype and more on the operational realities of implementing AI inside modern dental organizations.

The presentation challenged one of the biggest misconceptions surrounding AI in dentistry: that technology is here to replace people.Instead, the message was much more practical. AI is becoming a tool that helps practices reduce operational drag, improve consistency, and create more capacity for teams to focus on patient care. That distinction matters because dentistry is entering a period where operational efficiency is becoming a competitive advantage.

Practices today are balancing staffing shortages, rising patient expectations, tighter margins, and increasing administrative complexity. The groups that separate themselves over the next five years likely won’t be the ones chasing every new technology trend. They’ll be the ones who learn how to operationalize the right technologies effectively.

The Real Divide: Safe Bets vs Growth Bets

The presentation also highlighted a broader shift happening across dentistry. For years, many practices and organizations have leaned toward operational “safe bets”: legacy systems, disconnected workflows, manual processes, and incremental operational change. But growth-minded groups are beginning to think differently. They are investing in systems that reduce friction, automate repetitive work, improve calibration, and increase operational visibility across the practice, not to replace teams, but to enable them to operate at a higher level.

What will separate organizations over the next five years is not ownership structure or size. It will be their willingness to operationalize technology consistently across the organization. Because AI adoption by itself is not the advantage. The advantage comes from alignment:

and a willingness to rethink how practices operate as patient expectations continue evolving

AI powered dentistry

That shift is also changing how independent practices evaluate future partnerships and growth opportunities.

Historically, scale alone carried significant weight in dentistry. But as operational models mature, practices will increasingly seek out organizations with proven playbooks; groups who are capable of delivering integrated technology, operational consistency, workflow efficiency, and systems that meaningfully improve both the provider and patient experience.

In many cases, the differentiator will no longer be size alone. It will be operational maturity. That shift is happening across the industry, from independent practices to cooperatives to large DSOs, and organizations that embrace operational transformation early will gain significant long-term advantages in efficiency, patient experience, and sustainable growth.

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