By Megan Wyrick, Orthodontic Financial Consultant & Co-Founder, The Wyrick Outlook
Most dental practice owners can quote their production for the month. Far fewer can quote their collection rate. The gap between those two numbers is where most practices quietly lose money for years without noticing.
This is the topic we built the company around. Production means nothing without collections. We say it on every page, in every course, at every event. We say it because we have watched too many practices celebrate production records that never made it to the bank account. Collections is where production becomes business performance. Anything that does not get collected is, operationally, a gift the practice gave away.
What follows is the field guide we wish more practices had before they spent years chasing production numbers without protecting the collection rate underneath them.
Scope note: we coach orthodontic practices specifically. The mechanics below apply directly to general dentistry, periodontics, and oral surgery. Where the orthodontic version is meaningfully different (long-arc payment plans, lifetime ortho maximums, retention-period billing), we say so.
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See the FC TrainingWhat Are Dental Collections?
Dental collections is the practice’s actual revenue: the money that has been deposited into the bank after insurance has paid its portion and patients have paid theirs. The number is downstream of production (what the doctor recommended and the patient agreed to), upstream of profit (what is left after the practice’s overhead).
The collection rate is the percentage of production that actually gets collected. A practice producing $200,000 monthly and collecting $172,000 monthly is operating at 86% collection rate. The 14% that does not get collected is the leakage.
Collections work has two halves:
- Insurance collections. Getting the insurance carrier to pay what the plan owes for covered procedures. This includes claim submission, denial resolution, payment posting, and follow-up on aged insurance AR.
- Patient collections. Getting the patient to pay their portion. This includes copays, deductibles, out-of-pocket amounts, and any portion not covered by insurance.
Strong collections work treats both halves as connected. Weak collections work treats them as separate.
What Is a Healthy Dental Collection Rate?
The benchmarks vary by specialty and payer mix. As general guidance:
- General dental practices on a strong payer mix typically run 95%+ collection rate when systems are healthy.
- Orthodontic practices with well-managed payment plans typically run 92-95%.
- Pediatric and Medicaid-heavy practices typically run 88-92% due to higher patient-portion write-offs.
- Anything below 88% indicates a systemic issue that is worth solving before pursuing growth.
The most useful number for any individual practice is the trend. A practice at 90% collection rate moving toward 93% is on a healthy trajectory. A practice at 95% moving toward 91% has a problem developing, even if the absolute number still looks fine. Run the number monthly and watch the direction.
Why Most Dental Collection Rates Are Lower Than the Practice Realizes
Most practices we engage with for the first time believe their collection rate is higher than it actually is. The reason is the same as with case acceptance: measurement.
The collection rate calculation requires pulling 12 months of production data and 12 months of actual deposits, then dividing one by the other. Most PMS systems do produce collection reports, but the deeper blind spot is reconciliation. The number a practice sees in its PMS collection report is what was posted into the system. The number sitting in the bank account is what actually arrived. Those two numbers should match every single month. In a lot of practices, they don’t, and nobody is checking. The variance between what was posted and what was deposited is where errors hide, where missed deposits stale into write-offs, and where embezzlement exposure quietly compounds.
Without that single number, the practice cannot see the trend. Slow drift downward of 1 percentage point per quarter is invisible without the math. Three percentage points over a year is invisible without the math. Five percentage points over two years is the difference between a profitable practice and one that is one staffing crisis away from a cash flow problem.
From Megan Wyrick: When production focus quietly drowns out collections
The clearest pattern we see across drifted-collections-rate practices is not a complex one. It is a practice so focused on production that the collections side simply does not get monitored. Here is Megan on what that looks like:
“Most practices don’t monitor collections. They monitor production, and while production is great, collections is better as it’s money actually coming into the practice. We had a practice we worked with so production heavy that they weren’t paying any attention to collections. When we ran their collection report and noticed it was lower than it should be, we worked with them to implement a past-due protocol to clean up old accounts. The practice saw an increase in collections by 10-20K over the next few months while we worked to get things back on track.”
— Megan Wyrick, Orthodontic Financial Consultant and Co-Founder of The Wyrick Outlook
The clean takeaway is that recovering past-due collections often does not require any new production work. It requires running the report, finding the leakage, and working a structured protocol on what was already produced but not yet collected. The audit that surfaces this kind of gap costs almost nothing beyond the few hours required to actually pull the data.
The audit takes a weekend. The number it produces is the most useful single piece of information in the practice’s financial dashboard.
The Five Places Dental Collections Quietly Leak
Across the practices we coach, five leakage points account for most of what separates 95% collection rate from 88%. They are not random. They are predictable.
Leakage point 1: Insurance verifications that were wrong
If the verification missed a benefit detail, the treatment plan was wrong, the financial conversation was wrong, the claim that submitted was wrong, and the EOB that came back surprised the practice. The patient was told their out-of-pocket would be $1,200 and it turned out to be $1,800. Now the practice is either eating the difference, renegotiating the payment plan, or chasing an aged patient balance from a patient who feels misled.
This is why we put so much weight on verification accuracy. The TWO step verification protocol (phone plus supporting document) typically recovers 2-4 percentage points of collection rate over 90 days because it stops this specific leakage at the source.
Leakage point 2: Past-due patient AR that nobody is actively working
Every practice has a past-due patient AR list. Most practices run the list monthly, send statements to everyone on it, and move on. That is not collections work. That is paperwork.
Real past-due AR work is a structured outreach cadence with different scripts for different aging buckets. The 30-day patient gets a soft text. The 60-day patient gets a phone call. The 90-day patient gets a structured payment-plan conversation. The 120-day patient gets a final-notice letter. The 150-day patient goes through a documented decision about collections agency referral.
A practice that runs this cadence consistently recovers 30-60% of past-due patient AR within 60 days. Most practices recover almost none of it because they confuse sending statements with doing the work.
Leakage point 3: Failed autopay drafts that nobody catches
For practices with payment plans (most orthodontic practices), failed autopay drafts are a slow bleed. A draft fails. The patient’s card was declined for any number of reasons. The system tries again the next month. It fails again. By the time anyone notices, the patient is two payments behind.
A weekly review of failed drafts (every Friday, by the financial coordinator) catches this in the first failed cycle. The financial coordinator calls the patient warmly, updates the payment method, and the draft resumes. The patient does not feel hounded; the practice does not bleed payments quietly.
Leakage point 4: Insurance claims that were submitted but never followed up
A clean claim submission is the start of insurance collections, not the end. Most insurance carriers will pay clean claims within 30-45 days. Some will sit on them. Some will deny them for resolvable reasons. Some will pay partially with no explanation.
The team member working insurance AR needs a weekly cadence for following up on aged claims. Any claim aged 45+ days without payment gets called on. Any claim denied for a resolvable reason gets reworked and resubmitted. Without that cadence, aged insurance AR sits and stales until someone eventually writes it off.
Leakage point 5: No reconciliation between the PMS and the bank
This is the leakage point most practices have the hardest time seeing, and the one most likely to compound into something serious. The PMS records what gets posted as a payment. The bank records what actually shows up as a deposit. Those two numbers should match every month. In a lot of practices, they don’t, and nobody is comparing them.
The variance between what was posted and what was deposited is where errors hide, where missed deposits stale into write-offs, and where embezzlement exposure quietly accumulates. A staff transition (a financial coordinator quits, takes leave, or transitions out) amplifies this risk, because the institutional knowledge of which deposits matched which posts walks out the door. But the underlying problem is the missing reconciliation cadence, not the staff transition itself.
From Megan Wyrick: The reconciliation cadence that catches errors before they compound
This is the operating model Megan used when she worked inside a practice, and the one she recommends for every practice we coach:
“The biggest example that we see regularly is when practices don’t reconcile what they collect (the money posted within the PMS) to what is truly in the bank. When I physically worked in a practice I would run deposit reports, collections reports, and production reports that were handed over to a bookkeeper. She then reconciled the bank to confirm the payments posted within the PMS matched what was in the bank. If there was an error, it was caught immediately. There are so many practices who don’t do this and it eventually turns their numbers into a bigger mess and can expose the practice to embezzlement.”
— Megan Wyrick, Orthodontic Financial Consultant and Co-Founder of The Wyrick Outlook
The operational pattern is simple. Three reports out of the PMS (production, collections, deposits) reconciled monthly against the bank by a separate person, whether a bookkeeper, an external accountant, or an oversight service. Errors get caught the week they happen, not the quarter they happen. The single best protection against this leakage is documented procedures, cross-training so the work survives staff transitions, and either a remote billing service that does not turn over or a twoMONITOR-style oversight layer that provides the reconciliation cadence externally.
How to Build a Collections System That Actually Works
The system below is what we install for practices that hire us, and what we teach in the Master the Money™ course for practices that want to build it in-house.
Component 1: Weekly aging review
Every Friday morning, 30 minutes, financial coordinator and OM (or doctor). Pull the aging report. Review every account past 30 days. Document the action plan for each one. The conversation surfaces issues before they compound and creates accountability for the work.
Component 2: Structured past-due outreach cadence
Documented scripts for each aging bucket. The 30-day text. The 60-day phone call. The 90-day payment-plan conversation. The 120-day final notice. The 150-day collections decision. Build the scripts once. Run them forever. Modify them quarterly based on what is working.
Component 3: Weekly failed-draft review
Every Friday, before the aging review. Pull failed autopay drafts from the week. Call each patient warmly. Update payment methods. Resume drafts. This is a 15-minute task that prevents a 6-figure annual leakage in a payment-plan-heavy practice.
Component 4: Weekly insurance AR follow-up
Same day as the aging review. Pull aged claims (45+ days no payment). Call carriers on each one. Document the call reference numbers. Rework any denied claims that are resolvable. Move forward.
Component 5: Monthly collection-rate calculation
End of every month. Production divided by collections. The ratio. Track it monthly. Watch the trend. Address any drift in the next month’s work, not in the next quarter.
Component 6: Quarterly deep audit
Once per quarter, the OM or financial coordinator pulls the AR report and reviews it in detail. Patterns surface that are invisible from the weekly view. Specific carriers paying slower. Specific employers (and the plans they offer) producing more disputes. Specific patient demographics with higher past-due rates. The patterns inform what the next quarter’s work focuses on.
This is the operating system. It is not complicated. The problem is consistency. Most practices run the system for a month, then drift away from it when something more urgent comes up. The practices that run it forever are the practices that hold a collection rate over 92%.
Should You Outsource Dental Collections?
Insurance collections work is highly proceduralized, requires specialized expertise (codes, plan-language interpretation, payer behavior patterns), and does not directly touch patient trust. That makes it a strong candidate for outsourcing to a remote billing service.
Patient collections is different. Patient collections touches patient trust directly. The conversation about a past-due balance is part of the patient relationship. We removed patient AR from our remote billing service in January 2025 for exactly this reason. Doctors get sensitive (rightly) about how their patients are spoken to about money. The work is best kept in-house, where the practice’s relationships are.
The split most healthy practices land on:
- Insurance collections to a remote service (like our twoDO), or kept in-house with strong training.
- Patient collections kept in-house, with the financial coordinator running the structured outreach cadence.
- Training and reporting oversight through either structured training (like Master the Money™) or a twoMONITOR-style oversight layer that catches drift early.
What Most Dental Collections Content Gets Wrong
Most dental collections content frames collections as a back-office task. Get the front office to send statements, train the FC to call past-due patients, write better collection letters. Done.
That framing is incomplete. Collections is not a back-office task. Collections is the lagging indicator of the entire patient relationship. The patient who feels respected by the practice pays. The patient who feels misled, rushed, or surprised by costs does not. The collection rate is what the patient relationship looks like financially.
That is why the strongest collections work is not isolated to the FC. It is whole-practice operational discipline. The TC’s financial conversation is collections work. The doctor’s consultation tone is collections work. The OM’s hiring decisions are collections work. The verification accuracy is collections work. The FC closes the loop, but the practice produces the conditions that make closing possible.
From Megan Wyrick: Why the best collections systems keep doctors out of the day-to-day
This is the contrarian piece most dental consulting content does not say out loud. The typical advice tells doctors to “stay close to the collections work.” Megan’s experience says the opposite, and the math behind her reasoning is direct:
“Collections can be entirely personal to the practice. But it doesn’t have to be. Most times doctors get too involved with collections and that’s where we see a slippery slope. The reason is because doctors generally tend to play nice and have the mentality of ‘what’s the $130 monthly payment, it’s not hurting me,’ but one $130 payment quickly turns into 10, then to 50, then to 100, and slowly starts to eat at cash flow. Instead, doctors who overlook the collections but don’t meddle in the role tend to be much more successful. A great system is that the doctor should be looking at the monthly reporting, making sure the bank and PMS reconcile every month, and stay out of the day-in-and-day-out patient-facing collections.”
— Megan Wyrick, Orthodontic Financial Consultant and Co-Founder of The Wyrick Outlook
Two operational takeaways. First, the doctor’s role in collections is oversight, not enforcement. Monthly reporting and bank-to-PMS reconciliation are the doctor’s lane; the day-to-day patient conversations about past-due balances are not. Second, the slippery slope math is real. A practice that accepts 100 patients carrying $130 in delayed payments is carrying $13,000 in delayed monthly cash flow that the doctor approved one $130 decision at a time. The protection against this is a financial coordinator empowered to hold the line on payment-plan terms, with the doctor visible only in the monthly reports.
What’s the Next Step If You Want to Improve Dental Collections?
Three paths forward, depending on where the practice is.
If you are not sure what your collection rate is, start with the audit. Pull 12 months of production. Pull 12 months of deposits. Calculate the ratio. The number tells you the size of the problem.
If your collection rate is below 90% and the FC role is the bottleneck, the structured training path is Master the Money™. Whole-team admittance, PACE-approved, 4-6 CE units, on-demand. The course is built for the seat that owns the past-due AR cleanup work.
If the issue is insurance billing more than patient AR, the structured training path is Confused 2 Confident™, built for the IC role specifically.
If you want to move the insurance work entirely off your team’s plate, our twoDO remote billing service handles the full insurance side. US-based team, dedicated specialist, your PMS stays yours, 6-month initial commitment with month-to-month thereafter.
If you want oversight on in-house billing without full outsourcing, the twoMONITOR tier provides monthly AR review and weekly check-ins as the accountability layer.
The right path depends on where your specific leakage is. The first step is finding the number.
Frequently Asked Questions
What is a good collection rate for a dental practice?
For general dental practices on a strong payer mix, 95%+ is healthy. For orthodontic practices with well-managed payment plans, 92-95% is healthy. Anything below 88% indicates a systemic issue worth solving before pursuing growth. The most useful number for any practice is the trend over time; small downward drift compounds significantly across years.
How do I calculate my dental practice’s collection rate?
Divide actual collections by total production for the same period. Pull both numbers from a consistent 12-month window. Most practices have production in their PMS and collections in their bookkeeping software. Putting them in a single ratio is the work most practices skip and the work that produces the most useful number on the financial dashboard.
How long should it take to collect from insurance in dentistry?
Clean claims from most major carriers are paid within 30-45 days. Specific carriers (some Medicaid programs, some smaller employers, some union plans) consistently pay slower (60-90 days). Claims aged past 45 days without payment should be followed up on weekly. Claims aged past 90 days are at significantly higher risk of being written off and should get individual attention.
What is the difference between dental collections and dental accounts receivable?
Dental accounts receivable (AR) is the total amount the practice is owed at any given moment, broken into insurance AR (what carriers owe) and patient AR (what patients owe). Dental collections is the work of converting AR into deposits. AR is the snapshot; collections is the active work. A practice can have low AR and weak collections (because nothing gets billed in the first place) or high AR and strong collections (because the practice produces a lot and works the AR systematically).
Should dental practices use a collections agency for past-due patient accounts?
Sometimes, but later than most practices think. Collections agencies typically charge 30-50% of recovered amounts and can damage patient relationships if used too aggressively. The healthier pattern is running a structured in-house outreach cadence for 120-150 days before any external collections referral. Most past-due balances that can be recovered get recovered through the in-house cadence at lower cost and without burning the relationship.
About the Author
Megan Wyrick is the Co-Founder of The Wyrick Outlook and an Orthodontic Financial Consultant. With 15+ years of hands-on experience inside orthodontic offices, she focuses on the financial systems, insurance strategy, and operational discipline that move practices from reactive billing into confident, repeatable revenue cycles. The Collections First framework is the brand’s central thesis: production means nothing without collections. Her co-founder B Wyrick runs the operations and team-development side of the brand. Together they coach orthodontic practices through practical, peer-to-peer training that does not feel like consulting.