When I walk into a dental practice that’s running well, I know I’ll find good, repeatable systems everywhere.
Systems for answering the phone. Scheduling. Sterilization. Treatment planning, clinical notes, insurance verification, patient communication. Some of those systems were built on purpose, while others got handed down from whoever had the job before. Either way, they’re running, and generally running well.
Underneath all of it sits the one system that touches everything else: revenue cycle management. Revenue cycle management is what brings money into the practice and keeps it there. It pays your team. It buys your supplies. It covers the continuing education course, the new scanner, and the raise you’ve been meaning to give someone for a year now.
And somehow it’s still treated like a front-desk problem.
Revenue cycle management starts long before a claim is sent
Allyssa Mizenko.
Say “revenue cycle” out loud and most people picture billing and collections, or that aging report nobody wants to open. Those things matter, but they generally come toward the end of the patient’s journey and experience.
By the time balances are sitting and aging, the outcome was most likely decided weeks ago. Verification either happened or it didn’t. The narrative either backed up the code or it didn’t. The patient either understood what you were recommending, or they nodded and left with unanswered questions.
Revenue cycle management begins the moment a patient schedules an appointment and continues through every interaction until the practice has been paid in full.
That means every member of your team influences the revenue cycle. The scheduling coordinator sets expectations before the patient even walks through the door. The clinical team documents treatment accurately and completely. Hygienists educate patients and build value in recommended care. Dental assistants capture quality radiographs, photos, and clinical support. Doctors diagnose appropriately and communicate treatment effectively. The administrative team verifies benefits, submits claims, follows up on insurance, and collects patient balances.
Think of the revenue cycle like a relay race. Each member of the team has a critical role, handing the baton from one person to the next and carefully ensuring it doesn’t get dropped along the way. In a true relay race, a dropped baton results in immediate disqualification. It doesn’t matter if the team practiced hard or had the newest sneakers. The team will be disqualified.
The same is true in a dental practice. The practice doesn’t get paid because one person ran faster than another -- it gets paid because nobody dropped the baton.
When somebody does drop it, the money doesn’t always come back. A missing periapical radiograph can turn a legitimate crown into a denial. A vague narrative can turn a covered procedure into an appeal that never gets written. Revenue that leaves the practice this way rarely gets recovered.
The cost of working in silos
In my 13 years in this profession, one thing has remained consistently true: The practices that perform the best are the ones that eliminate silos and the walls between departments.
We’ve all heard it before: “That’s not my job,” or “Marcie at the front handles that.” These phrases usually aren’t laziness. They come from a team that’s never been shown how their piece connects to anyone else’s, or, worse, a team that got their hand slapped once for stepping outside their lane and learned not to do it again.
I’m a firm believer in roles and responsibilities and the importance of job descriptions. One of the biggest mistakes I see in practices is that when everyone is responsible for something, no one is held accountable for that same thing. And accountability matters.
I wouldn’t expect an insurance coordinator to set up and assist for an implant placement without proper training, and I wouldn’t expect a dental assistant to suddenly know how to reconcile and audit a patient’s financial account. Role clarity isn’t the problem. The problem is when role clarity hardens into a wall and the hand offs between roles become nobody’s territory.
Every team member contributes to whether a procedure gets completed, documented correctly, submitted appropriately, reimbursed accurately, and ultimately collected. Revenue cycle management isn’t owned by one department, it’s shared by the entire practice.
'I’m a hygienist. I can’t make someone pay their bill!'
True, you can’t. But you absolutely influence whether they believe their treatment is worth paying for. Every conversation in the operatory builds value or chips away at it. When a patient actually understands why treatment matters, they schedule it, they show up for it, and they pay for it.
Picture the same appointment two ways:
First version: A patient is told they need scaling and root planing, gets handed a treatment plan on the way out, is asked if they want to schedule, then leaves.
Second version: The patient sees their own bleeding points, looks at the perio chart with the numbers explained, sees the bone loss on their x-rays, hears what happens if this keeps going, and is offered an appointment within the next two weeks.
It’s the same patient, the same diagnosis, the same fee, but a completely different experience with value built in at every step. That’s revenue cycle management. It just doesn’t look like it.
Documentation works the same way. Missing periodontal charting, incomplete narratives, x-rays you can’t read -- those aren’t just chart problems. They’re money problems.
A carrier reviewing your claim never sits in your operatory. Your documentation is the only version of that appointment they will ever see. If the record doesn’t tell the story, as far as the carrier is concerned, it didn’t happen.
Your clinical team protects revenue every single day. Most of them have no idea they’re doing it.
How do you know if your revenue cycle is healthy?
Net production and net collections are commonly used to track the revenue cycle process, with a goal of collecting at least 98% of net production. Many consultants would agree that’s a healthy benchmark. But that number is a scoreboard; it doesn’t identify the specific nuances that could be affecting the process.
Ask yourself:
- Is verification getting done or getting skipped when the schedule is full?
- Are clinical notes lacking the documentation carriers require?
- Are claims being submitted late?
- Are attachments missing?
- Is case acceptance low because patients don’t understand the value?
- Is anyone actually working the outstanding claims or just looking at the report?
Most practices have a theory about what could be wrong, but it’s usually whichever step failed most memorably last month that becomes the focus. Without measuring the process, a theory is all it is, and teams end up fixing the loudest problem instead of the most expensive one.
Measuring the health of your revenue cycle
Throughout my years leading Zen Dental Support, one thing has become increasingly clear: Most practices don’t have a production problem, they have process gaps that quietly allow revenue to slip through the cracks.
Resolving denied claims will always be an important part of revenue cycle management. But when a practice spends most of its time chasing denials, it’s reacting to problems instead of preventing them. The stronger approach is to build systems that identify weaknesses before they become lost revenue.
That philosophy led us to develop two assessment tools -- not as report cards, but as a way to create visibility into the revenue cycle process. One examines the insurance verification process, evaluating its consistency, accuracy, and whether important details are being captured before treatment begins. The second looks at the broader revenue cycle, helping practices understand where systems are functioning well and where opportunities for improvement may exist.
Whether a practice uses these tools or simply takes a closer look at its own internal workflows, the goal is the same: Gain clarity. You can’t improve what you can’t see.
At the end of the day, revenue cycle management is about more than insurance, collecting co-pays, and sending out patient statements. It’s about protecting the financial health of the practice so the team can continue focusing on what matters most: providing exceptional patient care. And that responsibility doesn’t belong to one department. It belongs to every member of the team.
Allyssa Mizenko is the founder and CEO of Zen Dental Support, a revenue cycle management company dedicated to helping dental practices protect and optimize their revenue through stronger systems, smarter workflows, and aligned teams. Mizenko works with practices nationwide to reduce inefficiencies, prevent revenue leakage, and create sustainable, scalable growth. Contact her at [email protected].
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
