Dental Accounts Receivable: Your AR Number Is Hiding Two Different Problems

By Megan Wyrick, Orthodontic Financial Consultant & Co-Founder, The Wyrick Outlook

If your practice reports one accounts receivable number, you are looking at two unrelated problems stacked on top of each other and being asked to fix them with one action. It almost never works, and the reason is structural rather than anything your team is doing wrong.

Patient AR and insurance AR fail for different reasons, sit with different people, and need completely different work. Until you separate them, every conversation about “getting AR down” is a conversation about an average.

One note on wording first. We are orthodontic-specific. We coach ortho teams, and we run remote insurance billing through twoDO for practices that would rather not handle claims in-house. The broader “dental” language here is what practice owners actually search, but this is written for orthodontic practices, where treatment bills in installments across the full course of care and the AR behaves accordingly.

What is dental accounts receivable?

Dental accounts receivable is the total money a practice has earned but not yet collected. In an orthodontic practice it splits into two buckets: patient AR, which is what families still owe on their contracts, and insurance AR, which is what payers still owe on submitted claims.

Those two buckets behave nothing alike:

• Patient AR ages because there is no consistent protocol for working a balance once it goes past due. It is a process problem that shows up as a relationship problem.
• Insurance AR ages because a claim was denied, underpaid, never submitted, or submitted with the wrong information. It is a process problem with a money consequence.
• Patient AR is owned by the Financial Coordinator. Insurance AR is owned by the Insurance Coordinator. Different seats, different training, different fix.
• A single blended AR percentage will move if either bucket moves, which is exactly why it tells you so little about what to actually do on Monday.

AR sits upstream of your collections process, which is why a collection rate that will not improve is usually an AR problem wearing a different name. Far too often we watch practices put the cart before the horse here. They chase the total number, run a collections push, get a temporary dip, and then watch it climb right back because the underlying cause was never touched.

The distinction that costs practices the most money

The FC and the IC are sibling roles, not the same job. We are strict about this in our own copy because the blur is expensive.

The Financial Coordinator handles money between the practice and the patient: contracts, down payments, payment plans, past-due balances, and the conversations that go with all of it.

The Insurance Coordinator handles money between the practice and the payer: verification, claim submission, EOBs, coordination of benefits, work-in-progress billing, and appeals. If you are not sure what that seat is accountable for day to day, we break the role down here.

Plenty of practices run both through one person. That is a staffing reality and sometimes unavoidable. What is avoidable is training that person for only half the job and then wondering why one half of the AR keeps aging. If one person carries both seats, they need both courses, and one registration covers the whole team, so the doctor and the OM can sit through the same material.

	Patient AR	Insurance AR
Who owes the money	the family	the payer
Who owns it in the practice	Financial Coordinator	Insurance Coordinator
Most common root cause	no consistent past-due protocol, so follow-up depends on who remembers	claim denied or underpaid, and never appealed
How it is fixed	a written protocol with a defined action at every aging stage	verification at the front end and disciplined appeals
What it feels like when it fails	awkward conversations nobody wants to have	a stack of claims nobody has time to rework
Where the training lives	financial coordinator training	insurance coordinator training

Where patient AR actually comes from

When we ask financial coordinators what they most want help with, they do not ask about software. They ask about specific, uncomfortable moments. These are real questions from our own course survey, and they are the honest shape of the problem:

• “How do I debond a patient whose account is past due, and what do I do if I cannot reach them after the braces come off?”
• “At what point do you dismiss a patient for non-payment?”
• “What are the indicators that a patient has no intention of paying?”
• Divorced parents and split responsibility, FSA and HSA accounts, when to involve a collection agency, and whether to report to credit, all from one coordinator in the single most detailed answer anyone gave us.

Notice that none of those are reporting questions. They are decision questions. And that is the tell, because the answer to every one of them is the same missing thing.

The most common root cause we see in practices with past-due patient AR is not having a consistent past-due protocol. The FC does not have a structured game plan or a roadmap for dealing with delinquencies as they continue to age month after month. So each balance gets handled from scratch, by whoever happens to notice it, with whatever the office is willing to do that week.

I cannot tell you how much this hurts a practice, and the second a consistent protocol is put into place, the past-due accounts scatter.

That is the part practices underestimate. They assume aged patient AR is a collection of difficult individual families, so the fix must be difficult too. Usually it is one structural gap producing dozens of stalled balances, and closing that gap moves most of them at once.

Which is why the practices that keep patient AR low are not the ones with the best software. They are the ones where the FC knows exactly what happens at 30 days, at 60, at 90, and at debond, and does not have to ask permission each time.

Where insurance AR actually comes from

Insurance AR is a different animal because most of it is decided before the claim is ever sent.

Verification decides more of what happens later than any other step in the cycle, and it is the one most often rushed. If the benefit limits, frequency, lifetime maximum and coordination of benefits are wrong at the start, the claim is going to fail later and the practice will find out weeks after the fact.

Work-in-progress billing is the other place ortho practices lose money that general dentistry never has to think about. Treatment bills in installments over the course of care, so a claim submitted against the wrong phase or the wrong date range gets denied for reasons that look mysterious unless you know the mechanic.

Then there is the part that is purely about discipline. Denied claims get rewritten and resubmitted far more often than they get appealed, because rewriting feels faster. Rewriting a claim that was denied for a legitimate coverage question just produces a second denial.

For practices that would rather not carry that in-house at all, that is the work our remote insurance billing team does. One thing worth stating plainly: twoDO is insurance-only, and has been since January 2025. We do not work patient AR. That side stays with your FC, which is exactly why the FC needs to be trained for it.

Two practices we worked with give a sense of what disciplined insurance AR work does. One moved insurance AR from over 12.5 percent to under 5.5 percent in under two months. Another went from 21.62 percent to 1.67 percent over six months.

The 30-day AR cleanup

If you want to move the number rather than discuss it, this is the order we would work in.

1. Split the report. Pull patient AR and insurance AR separately, aged into 30, 60, 90 and 120-plus buckets. If your practice management system cannot separate them cleanly, that is the first thing to fix. Nothing below works on a blended number.
2. Write the patient-side protocol down. Do this one first even though it feels like paperwork, because it is the root cause rather than a symptom. What happens at each aging stage, who does it, what they say, and what the practice is prepared to do at debond. The wording matters less than the fact that it exists and nobody has to improvise.
3. Find the cliff. In almost every practice, one aging bucket holds most of the balance. Work that bucket first rather than starting at the top of an alphabetical list.
4. Sort insurance AR by reason, not by age. Denials, no response, underpayments and never-submitted are four different work queues. Batching by reason is dramatically faster than working chronologically.
5. Fix verification going forward. Cleaning up aged AR without fixing intake means doing this again next quarter. Get the verification at the front end right and the next cohort of claims behaves.
6. Pick the number you will watch. Aged insurance AR over 90 days is the one we would choose. Look at it monthly, not annually.

If the aged balance is big enough to be intimidating

This is where most practices stall, and it is worth naming directly. A practice that has never separated the two buckets opens the report, sees how far back the balances go, and decides to come back to it when there is time. There is never time.

Practices intimidated by aged balances need to just step in and start. Starting is half the battle.

And do not let step 2 become the reason you delay. You are not going to have a protocol for every situation you will encounter, and you do not need one to begin. Write down what you do know, work the balances in front of you, and add the next situation to the protocol the first time you hit it. In a few months you will have one, built out of real cases rather than guesses. Waiting until the document is complete is how a practice spends a year not collecting.

Why this is different in orthodontics

There is a testimonial we come back to often, from someone who came to us after a decade in general dentistry: “Even with 10 years of dental office management under my belt, orthodontics is a whole world. This course has helped me feel more confident in my new role.”

That is the honest version. Ortho AR is not general dental AR with different codes. Treatment bills over 18 to 30 months, patients pay across the same window, insurance pays in installments against a lifetime maximum, and the debond date creates a hard deadline that general dentistry simply does not have. A practice running general dental AR habits on an ortho ledger will age money and not understand why.

Frequently Asked Questions

What is a good accounts receivable percentage for an orthodontic practice?

Rather than chase a single benchmark, split the number first. We would rather see a practice with a clear view of aged insurance AR over 90 days and a written patient-side protocol than one hitting a target blended percentage it cannot explain. Once the buckets are separate, the trend matters more than the absolute figure, because it tells you whether your process is working or you just had a good collections month.

Who should own accounts receivable in a dental practice?

Both seats own a piece. The Financial Coordinator owns patient AR, which is contracts, payment plans and past-due balances. The Insurance Coordinator owns insurance AR, which is claims, denials and appeals. If one person is doing both, they need training for both. The whole-team version of that is training assigned by seat rather than by availability.

What is a past-due protocol, and why does it matter so much?

A past-due protocol is a written roadmap for what the practice does at each stage a balance ages through: 30 days, 60, 90, and at debond. It names the action, the person, the wording, and how far the practice is prepared to go. It matters because the absence of one is the most common cause of aged patient AR we see. Without it, every balance is handled from scratch by whoever notices, which means most of them are not handled at all.

Can you outsource dental accounts receivable?

You can outsource the insurance side. Our twoDO team handles verification, claim submission, insurance AR follow-up, payment posting and denied-claim resolution, working inside your existing practice management system so your data stays with your practice. We do not take on patient AR, and we would be cautious of any service that offers to, because those conversations are relationship work that belongs inside your office.

How long does it take to bring aged AR down?

It depends almost entirely on which bucket is aged and why. Insurance AR responds faster because the work is procedural. Two practices we worked with moved from over 12.5 percent to under 5.5 percent in under two months, and from 21.62 percent to 1.67 percent over six months. Patient AR usually takes longer, because you are rebuilding a follow-up habit and working through balances where the relationship has already gone quiet.

What is work-in-progress billing and why does it affect AR?

Work-in-progress billing covers treatment that is underway but not complete, which is the normal state of nearly every active orthodontic patient. It has no equivalent in general dentistry. Claims submitted against the wrong treatment phase or date range get denied for reasons that look arbitrary unless the coordinator understands the mechanic, and those denials are a meaningful share of aged insurance AR in most practices we open up.

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Megan Wyrick is a co-founder of The Wyrick Outlook, where she helps orthodontic practices run clean revenue cycles and collect what they have already earned. With 15 or more years in orthodontic financials, insurance and collections, she has worked nearly every seat on the money side of an ortho office. Megan and her sister B have partnered with more than 450 practices. More about Megan.

Posted by Megan Wyrick