The Dental Billing Podcast

Dental billing is not data entry. It's the difference between a practice that collects what it earned and one that writes it off and calls it the cost of doing business. The Dental Billing Podcast is hosted by Ericka Aguilar and Jen Lyman, RDH. Ericka has been a dental biller since 1998 and has taught billing in 31 states and Mexico. Jen came out of the operatory and now runs Lyman Revenue Solutions, handling both dental and medical billing. One of us knows exactly what the carrier is going to do with your claim. The other one knows what actually happened in that chair. You get both. Every week we break down denials, appeals, coding, and the carrier behavior nobody warns you about, in plain language, with real sources. We teach the law before the codes, because a code doesn't win an appeal. Knowing what that carrier is legally required to do wins the appeal. If you've ever been told you're "just the biller," this show is for you. Downloads in 114 countries and counting. Bring your coffee and your worst denial.

The Dental Billing Podcast is a business podcast hosted by Unknown Host, with 126 episodes on record and a Required Pod Score of 80.

Unknown Host hosts The Dental Billing Podcast, a business show with 126 episodes published.

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  The Dental Billing Podcast

  When AI Denies Your Claim with Dr. Amberena Fairlee

  Sep 15, 202628 min

  Most dentists know the insurance system is broken. Far fewer know what it actually takes to change it. Dr. Amberena Fairlee does, because she has been in the room in Salem and in Washington DC doing it. Jen sits down with Dr. Fairlee, a general dentist in Bend, Oregon, owner of Cascadia Family Dental, and the current president of the Oregon Dental Association, for a conversation about advocacy: what organized dentistry can realistically move, what it cannot, and why declining membership makes every one of those fights harder to win. If you have ever wondered whether a day away from the chair is worth it, or what your association is actually doing with your dues, this one answers both. In this episode: Why insurance is a coupon book and not a benefit, and how to explain that to patients without losing them Healthcare requires a diagnosis: the verbiage Dr. Fairlee gives her team when patients push back on exams and x-rays Why membership is the lever, and why quitting the association because you have not seen change yet makes change less likely What insurance reform legislation actually looks like: small incremental wins and closing loopholes, not raising annual maximums by decree ERISA self funded plans claiming they do not have to follow state insurance regulation, and why that is a focus in DC AI in claim adjudication: requiring disclosure when AI denies a claim, requiring human review without an appeal, and the patient privacy questions nobody has answered The one payer behavior she would outlaw tomorrow: diagnostic and preventive care no longer counting against the annual maximum Jen's wish list for the ODA agenda: diagnosis codes across the board, and an end to the appeal cycle on unreasonable denials The dental assistant and hygiene workforce shortage, and how staffing gaps push private practices toward being bought Why she gives up clinical days: advocacy makes her a more compassionate clinician Leadership without being loud: be at the table, and someone will amplify your voice About our guest Dr. Amberena Fairlee is a general dentist in Bend, Oregon and the owner of Cascadia Family Dental. She started in the profession as a dental assistant straight out of high school, earned her Bachelor of Science from Portland State and her dental degree from OHSU in 2017, and still holds an expanded dental assistant certificate from the Oregon Board of Dentistry. She is the current president of the Oregon Dental Association and the association's representative to the Oregon Board of Dentistry, including its Dental Assistant Workforce Shortage Advisory Committee. She also serves with the ADA's workforce ambassador group and an Oregon Health Authority healthcare workforce group. Dentists who want to get involved in Oregon can reach the Oregon Dental Association through its website, or contact executive director Barry Taylor, who can point you to the right place to start. Follow the practice on Instagram: @cascadiafamdental Send us Fan Mail Registration Link for Diagnosis Codes on a Dental Claim Form Webinar: https://dentiqhub-diagnosis-codes.vercel.app/ Get your Dental Billing Toolkit Here: https://www.dentalbillingdoneright.com/the-dental-billing-toolkit Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

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  The Dental Billing Podcast

  REPLAY: Avoiding Prison with Defensive Documentation with Dr. Roy Shelburne

  Sep 2, 202649 min

  A dentist, practice owner, and self-described “billing and documentation geek” sits down with us and tells a story most of dentistry never expects to hear: Dr. Roy Shelburne was convicted and went to prison after years of investigation tied to his Medicaid-heavy practice. The numbers are not the point. The system is. If you think “we didn’t mean to” protects you, this conversation will change how you look at dental billing compliance and clinical documentation. We dig into the uncomfortable legal reality behind intent to defraud, including “blind disregard,” where repeated errors without a system to find and fix them can be treated as fraud. From there, we get practical fast: what defensive documentation looks like before a claim is ever sent, why diagnosis must come before treatment, and how dentistry is inching toward more diagnosis-driven workflows (think ICD-10, not just CDT codes). Perio examples make it crystal clear: if the record doesn’t state the diagnosis, your SRP and inflammation-based codes are standing on thin ice. We also talk audit triggers you can prevent today: crown claims with no justification in the chart, radiographs that are not diagnostic, and documentation gaps created when notes get entered later or copied from rigid templates. Dr. Shelburne shares how to delegate documentation safely with flexible templates, how to track non-diagnostic radiographs to improve training, and how to stop “billing to benefit” so your treatment aligns with standard of care. We close with appeal strategies, payer criteria, and the mindset that helps you get paid what you are legitimately owed while lowering risk. If you want fewer denials, fewer clawbacks, and more peace of mind, listen, share this with your team, and then subscribe and leave a review so more practices build safer systems. Send us Fan Mail Registration Link for Diagnosis Codes on a Dental Claim Form Webinar: https://dentiqhub-diagnosis-codes.vercel.app/ Get your Dental Billing Toolkit Here: https://www.dentalbillingdoneright.com/the-dental-billing-toolkit Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

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  The Dental Billing Podcast

  Protocol Vs Standard Of Care In Dental X Rays with Jen Lyman, RDH

  Aug 25, 202634 min

  Someone on the internet said it’s “no longer protocol” to take x-rays at recall, and that one word is where the real danger starts. Radiographs are not a habit we do on a timer. They’re part of a provider’s standard of care, and that standard of care is a clinical decision the treating doctor owns, documents, and can defend. We walk through the practical difference between protocol and standard of care, then get specific about what the ADA and FDA patient selection guidance actually says (and what it does not say). We talk ALARA, why fixed schedules can be just as problematic as blanket “never” rules, and why the order matters every time: clinical decision first, money second. If you’re seeing more payer pushback and “clinical justification” requests, this conversation gives you language that protects both patients and the practice. Then we get into the part billers and office managers can use immediately: what not to write in the chart or claim remarks, how fraud vs abuse is evaluated, and how an undocumented service can look identical to an unnecessary one during an audit. You’ll hear ready-to-copy narrative examples that include indication, findings, diagnosis, and disposition, plus a clear explanation of diagnosis coding, ICD-10, and how the ADA dental claim form fields (including diagnosis pointers) help a payer understand the story of the tooth. If you want fewer denials and stronger appeals without letting insurance steer treatment, press play, share it with your clinical team, and bring your ugliest examples. Subscribe, share with a teammate, and leave a review so more dental billers can find this and document with confidence. Send us Fan Mail Registration Link for Diagnosis Codes on a Dental Claim Form Webinar: https://dentiqhub-diagnosis-codes.vercel.app/ Get your Dental Billing Toolkit Here: https://www.dentalbillingdoneright.com/the-dental-billing-toolkit Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

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  The Dental Billing Podcast

  Ericka Aguilar Gets Interviewed (Finally)

  Aug 23, 202627 min

  Send us Fan Mail A lot of dental billing advice online is loud, confident, and wrong and the cost shows up months later as denials, write-offs, and clawbacks. So we flipped the mic and let you meet Erica, the person behind years of dental billing education, revenue cycle management consulting, and a whole lot of hard-won pattern recognition from inside real practices. We talk through her path from a “natural-born geek” who literally tried to steal homework, to becoming a teen mom who needed a stable career fast, to discovering that the dental front office was where she belonged. From there, she builds a billing company at 22, partners in dental practices, and eventually creates Dental Career College after seeing how hard it is to hire and train great front office teams. Along the way we dig into what offices actually asked for most: stronger verbal skills on new patient calls and real competence with dental insurance claims and billing systems like Dentrix. Then we get practical about the issues that keep practices stuck: denial management without a standard process, confusing “we did it” with “will insurance pay,” and letting coverage rules creep into clinical decision-making. Erica shares why billers must keep up with updated CDT codes, invest in continuing education, and prepare for diagnosis codes and AI in dentistry, because the billing landscape is changing fast and it will leave people behind. Follow us for tips and updates, and don’t miss the upcoming live webinar: bring your denials and your questions. If this helps, subscribe, share the episode with your office, and leave a review so more dental teams can find it. Registration Link for Diagnosis Codes on a Dental Claim Form Webinar: https://dentiqhub-diagnosis-codes.vercel.app/ Get your Dental Billing Toolkit Here: https://www.dentalbillingdoneright.com/the-dental-billing-toolkit Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

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  The Dental Billing Podcast

  Credentialing Do's and Don'ts with Jen Lyman - RDH

  Aug 17, 202638 min

  Send us Fan Mail The fastest way to break a dental billing system is to assume the hard part starts after treatment. We sit down with Jen Lyman, now officially my co-host, and get honest about what really determines whether your dentistry turns into clean reimbursement: credentialing setup, correct identifiers, accurate provider records, and documentation that can actually support what you code. Jen shares her path from full-time clinical hygiene to building Lyman Revenue Solutions, including the burnout and physical strain that pushed her out of the chair and into the revenue cycle world. From there, we dig into the credentialing pitfalls we see constantly, especially the Type 2 NPI issue that feels “optional” until you add an associate, open a new location, or stop practicing. We talk about how contracts tied to the wrong entity create messy fixes, compliance risk, and audit exposure that can reach years back. We also get practical about operations: why provider list cleanup and fee schedule maintenance almost never happen inside practice management software, and how a monthly “billing CEO day” can prevent denials and confusion. Then we go deeper into coding and documentation, including the debates around CDT codes like D0180 and D4346, why coding is not the same thing as coverage, and why diagnosis codes on the dental claim form are becoming non-negotiable. If you want stronger claims, fewer surprises, and a team that speaks the same language from chairside to the front desk, this is for you. Subscribe, share this with your office manager or lead hygienist, and leave a review so more dental teams can find the show and fix the problems that never should have started. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here: https://4063-dentiq.systeme.io/waitlist Get your Dental Billing Toolkit Here: https://www.dentalbillingdoneright.com/the-dental-billing-toolkit Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here: https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header Schedule a billing chat with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Email Ericka: ericka@dentalbillingdoneright.com Email Jen: jen@dentalbillingdoneright.com

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