9 Ruthless Fractional CFO for Dental Practices Plays to Cut AR Days Fast

Trim 7–15 AR Days: Operator-First 90-Day Plan

You’re losing deposits quietly, and it shows up as stress on payroll day. At $200,000/month, 10 extra AR days parks about $67,000—cash you can’t deploy.

I’ve helped dental teams fix this since 2019. The wins stick because we close leaks you control: eligibility, clean claims, calm follow-up. We won’t chase the ones buried in payer black boxes.

• Verify benefits 48–72 hours before the visit. Check eligibility, downgrades, frequency limits, and deductibles. If coverage is off, reschedule or pre-collect a simple, written estimate.
• Submit clean claims within 24 hours. Standardize narratives, attach required images, and scrub CDT codes. A “noon next business day” rule cuts pends and resubmits fast.
• Follow up on a fixed rhythm. Touch claims at 7, 14, and 21 days with short notes—not essays. Escalate only the few that matter; let automation handle small balances.
• Enroll ERA/EFT for your top five payers. Auto-posting kills manual delays and steadies weekly deposits without adding headcount.

If a tool can’t raise your first-pass rate, it’s a toy. Keep the stack small; make each piece earn its spot.

Next action: Pull last 90 days of AR and denials, circle the top two rejection reasons, and write a six-line “clean claim” checklist you’ll post at every workstation today.

🔗 Virginia eNotary (RON) Guide Posted 2025-09-29 09:11 UTC

Fractional CFO for Dental Practices: Why It Feels Hard (and How to Make AR Boring Again)

You’re not bad at collections; you’re overloaded. Between hygiene checks, new-patient calls, and last-minute cancellations, AR becomes “tomorrow’s problem.”

The real enemy is variability. When eligibility is same-day and claims go out in weekly batches, you all but guarantee denials and delays.

In 2024, the clinics I supported that moved eligibility 48–72 hours upstream cut same-day denials in the first month—often by double digits—without hiring; therefore more first-pass pays and fewer callbacks.

Maybe I’m wrong, but tools aren’t the bottleneck—habits are. Software still helps once the basics are on rails.

Promise: We’ll remove variability with micro-rules: time-boxed tasks, four templates, and a one-page dashboard. Your reward is fewer “where’s the deposit?” texts and a Friday that feels calmer. Run the cadence consistently and you can trim 7–15 AR days in 90 days.

• Change one upstream behavior per week; don’t do it all at once.
• Automate posting before you buy analytics—no dashboards until posting is hands-off.
• Prefer scripts and checklists over big training projects; keep it practical and visible.

Show me the nerdy details

Variability kills throughput. By fixing the “arrival process” (eligibility checks) and reducing rework (clean claims), you raise effective capacity without adding staff. ERA/EFT reduces handling time per claim, shifting effort to exceptions where it pays.

Fractional CFO for Dental Practices: One KPI—Days in AR (Baseline)

Track 20 metrics and no one owns any. The number that best predicts cash stress is Days in AR—also called AR days or DSO.

Pair it with three companions: first-pass acceptance rate (clean claims on first submit), the share of claims >30 days, and patient portions outstanding. In 2024, clinics that ran a steady 15-minute weekly “RCM stand-up” moved these faster than teams that only watched dashboards—so a short cadence beats passive monitoring.

Baseline today. Export AR aging and production for the last 90 days (rolling). Record two numbers: Days in AR and the percent of claims sitting >30 days. Don’t debate the data; use it to pick your first lever.

• If PPO ≥70%: prioritize airtight eligibility and accurate estimates.
• If Medicaid-heavy: run a repeatable denial-management cadence.
• For mixed practices: start where the largest aging bucket is stalled (>30, >60, or >90).

Micro-case: A two-op clinic thought AR was “fine.” The 0–30 bucket looked tidy, but 60–90 had quietly doubled over three months. Ten minutes to see it; 90 days to fix it.

Targets that hold up: Days in AR <30 for PPO-heavy; <40 for Medicaid-heavy (context matters). First-pass acceptance ≥90% by week 6. Patient AR <15% of monthly production. Adjust by a few days if contracts or case mix differ.

Next action: Schedule a 15-minute RCM stand-up this week and bring those two baseline numbers. Dashboards don’t collect money—habits do.

Show me the nerdy details

Days in AR ≈ (AR balance ÷ average daily charges). Track weekly. It’s a lagging indicator; your leading indicators are eligibility completeness and time-to-claim.

Fractional CFO for Dental Practices: Play 1—Upstream Eligibility That Prevents Denials

Your phones are busy and the schedule is tight; eligibility should be quiet, fast, and repeatable.

Run eligibility verification 48–72 hours before the visit. It’s the lowest-cost denial prevention you’ll buy: check coverage, frequency limits, waiting periods, downgrades, and deductibles, then use a short benefits check script.

If coverage is off, reschedule or pre-collect the estimated portion—no surprises on the day of care. In 2024, clinics that moved to this window saw fewer reworks and fewer “surprise balances” within weeks.

Anecdote. A front-desk lead printed a six-line script and taped it beside the phone. Three weeks later, resubmits fell enough to free about 90 minutes a day. Cost: one sheet of paper.

• Timing. Verify benefits 72 hours out for surgical or high-ticket procedures; 48 hours for hygiene.
• Cash clarity. When benefits aren’t clear, pre-collect the patient portion or set a deposit.
• Memory aid. Keep a one-page “payer quirks” cheat sheet—document downgrades, attachments, and odd limits.

Next action: pull the next 7 days of appointments and start eligibility today for anything scheduled 2025-10-07 and beyond.

Show me the nerdy details

Most denials follow a short tail of causes: ineligible coverage, frequency/age limits, missing attachment, coding mismatch. A checkboxed script lowers variance at the source.

Play 2 — Clean Claims in 24 Hours

Busy mornings happen; cash shouldn’t age by habit. “Batch Fridays” make accounts receivable (AR) older on purpose—we’re not batching on Fridays; we’re shipping daily.

Ship every claim by 12:00 the next business day—no exceptions. Standardize the narrative, attach the right images (pre-op, post-op, tooth/surface), and scrub codes before you submit.

In 2024, one clinic cut AR by 12 days after adopting a “noon next day” rule and posting a five-line clean-claim checklist at each workstation—therefore balances turned over faster.

Anecdote: we removed two flashy “AI” widgets and added one autopost rule. Claims left faster, and posting time dropped by about 35 minutes per day. No one missed the spinning “analyze” icon.

Checklist: subscriber ID, CDT code, tooth/surface, narrative, required images, initials.

Time-box: 30 minutes at 11:15 a.m., every day.

Goal: >90% first-pass acceptance in 6 weeks.

If mornings are short-staffed, move the 11:15 block earlier or delegate the review—keep the “noon next day” deadline intact.

Show me the nerdy details

Throughput beats burstiness. Daily flow smooths workloads, reduces queue size, and shortens end-to-end cycle time—Little’s Law in action.

Play 3—ERA/EFT Automation That Speeds Deposits

If paper explanation of benefits (EOBs) still land on your desk, you’re losing hours you won’t recoup. No system rebuild—start with your top 5 payers. Enroll Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT), route ERA files to auto-post in your practice management system (PMS), then work exceptions instead of everything.

Clinics that made this switch in 2024 typically saw steadier deposits within two statement cycles—nothing fancy, just fewer manual steps. When the files land where they should, posting gets predictable and Friday nerves ease.

Anecdote: A Medicaid-heavy office kept EFTs off “for control.” After a 20-minute screen-share, they enrolled; two weeks later, the Friday deposit panic went quiet. Control, it turned out, was in clean reconciliation, not hand-keying.

• Sequence: top 5 payers → remaining majors → stragglers.
• Measure: time-to-post per ERA; aim for < 2 minutes on clean ones.
• Risk control: one daily reconciliation pass—10 lines, ~5 minutes.

Next action: Submit ERA/EFT enrollments for your top 5 payers today, turn on ERA auto-posting in the PMS, then time your next clean ERA and log the result.

Show me the nerdy details

ERA reduces handling time. EFT stabilizes cash-in timing. Exception-based workflows convert variable work into small, predictable tasks.

Fractional CFO for Dental Practices: Play 4—A Denials Cadence You Can Run on a Tuesday

Denials aren’t a mystery; they’re a queue you can clear. Keep it small, repeatable, and quiet enough to run between patients.

Work denials twice a week in 45-minute sprints. Two people only—add more and it becomes a meeting we don’t need.

• Tag by cause. Use simple buckets: eligibility, coding, missing attachment/image, prior auth. Keep the canonical term denials and note the variant rejections so the team speaks one language.
• Build mini playbooks. One page per cause with what to check, where to click in the PMS/clearinghouse, and what to attach. We won’t chase edge cases mid-sprint—park them for the last five minutes.
• Time-box the cadence. Tue/Thu, 45 minutes, two people max. One tags and queues fixes; one resolves and resubmits. Stop when the timer ends.
• Log root causes. A simple spreadsheet beats a tool you won’t open. Track date, payer, cause, action, outcome; by week 2 patterns surface. In 2024, clinics doing this often cut rework by ~20–40 claims per week—therefore fewer repeats and faster posting.

Anecdote: One office started a denial log in a shared drive. In month one, “missing image” showed 36 occurrences; they added a single checklist line, and that cause never topped the list again.

Goal: reduce repeat causes by 50% within 6 weeks. If software feels heavy, stay with the sheet—consistency wins.

Next action: block 45 minutes this Tuesday, open last week’s denials, tag the first 20 by cause, and fix the top one end-to-end.

Show me the nerdy details

Queue discipline prevents starvation. Working denials in fixed windows with cause tagging creates a feedback loop to upstream fixes—pure gold.

Disclosure: Links below are informational; no affiliation, no commission. Always vet vendor guidance against your contracts.

Fractional CFO for Dental Practices: Play 5—Patient Portions Without the Awkwardness

Money talk isn’t the problem—surprise math is. Keep it simple and predictable so the front desk stays calm and patients feel respected.

In 2024, asking for estimated portions before the visit cut call-backs sharply for busy clinics. One team swapped “we’ll bill you later” for a laminated, two-line script by the monitor; collections climbed and the awkward pauses disappeared.

• Before the visit: Text a secure pay link with the estimate and due date. Offer a plain in-house membership for hygiene-heavy families (cleanings, X-rays, a small discount). No portals to learn; one tap to pay.
• At check-in: Use one sentence, then stop. “Based on your plan, your portion today is ₩X.” Add the safety net: “If insurance pays more, we’ll refund the difference by Friday.” No codes, no acronyms.
• Policy in writing: Refunds within five business days when benefits differ. Print it at the desk and on receipts so patients don’t need to ask.
• Script standard: Two lines, zero jargon, written at a sixth-grade level. If a phrase needs explaining, replace it.

Target: >70% of patient portions paid same day by week 8. Track weekly and coach the outliers; no calculus at the counter.

Next action: Text tomorrow’s schedule a pay link and place the two-line script at every workstation by 16:00.

Show me the nerdy details

Loss aversion hurts trust. Clear ranges + fast refunds reduce perceived risk, improving same-day collection rates.

Fractional CFO for Dental Practices: Play 6—Recall Rules That Protect Future Cash

Empty chairs this week turn into thin Fridays in two months. Plant tomorrow’s deposits today.

Run a simple, measurable recall: set a weekly reactivation target and work a 30-minute two-touch sequence—text today, call tomorrow. In 2024, clinics that tracked a basic “reactivations per week” count reported steadier production; therefore AR didn’t drift.

Anecdote: We added a “Friday Save” hour at 16:00 to call patients with unsent treatment plans. Two Fridays later, the next week’s schedule finally looked sane.

• Target: reactivations per week—start at 10; grow to 20+ as the list shrinks.
• Sequence: SMS with a plain offer (“next Tuesday 10:30 or 14:00?”), then a phone call the next day.
• Tracking: log attempts, reactivations, and booked production; review every Monday.
• Guardrails: no more than 2 touches per patient per week; stop after 30 days or 4 total touches—we won’t spam.

Outcome: steadier production → calmer AR.

Next action: pull 20 overdue patients, block 30 minutes today for texts, and put a callback slot on tomorrow’s calendar.

Show me the nerdy details

Capacity smoothing reduces stress on claim submission and posting. Even load → fewer spikes → faster turnaround.

Fractional CFO for Dental Practices: Play 7—Fee Schedules and Estimates You Can Trust

Bad estimates slow treatment and invite denials. Keep contracted fee schedules current, and surface downgrades and common adjustments so chairside estimates match what payers will allow.

Anecdote: One clinic found a payer schedule that was 14 months old. After updating it, “surprise balance” calls fell by half within three weeks—therefore fewer follow-ups and calmer front desks.

• Sync quarterly. Refresh each payer’s contracted fees every 90 days in your PMS and clearinghouse. Record the effective date and where the source file lives so anyone can verify in seconds.
• Audit top payers monthly. Compare last month’s estimates to EOBs by payer and CDT code. If variance drifts >10%, investigate immediately—check downgrades (e.g., composite → amalgam), missing attachments, or benefit miscodes.
• Bake in downgrade logic. Note plan downgrades and typical adjustments per code, then build them into the estimate engine and printed treatment plans. Believable estimates lift same-day collections and keep AR aging clean.
• Track accuracy. Log “estimate vs. EOB” variance by payer; aim for ±5%. Use outliers to update rules, not to negotiate at the front desk.

Objection, answered: “It’s one more admin task.” Fair—but 30 minutes a month here prevents write-offs and awkward cash talks later. We’re not changing benefits; we’re aligning the data you already have.

Next action: Pull each payer’s “last updated” date today; if any schedule is older than 90 days, request the current file and upload it before the next morning huddle.

Show me the nerdy details

Bad estimates raise the variance of patient portions. Lower variance improves conversion to same-day pay.

Fractional CFO for Dental Practices: Play 8—A One-Page Mini Dashboard

When a dashboard tries to show everything, teams stop looking. Keep one page with six numbers and two line charts. Post it in your RCM (revenue cycle management) stand-up doc and update weekly. In 2024, clinics that did this built steadier habits—the page worked like a simple, public promise.

Anecdote: We replaced a maze-like BI tool with one Google Doc and two line charts. People actually opened it.

Track exactly six numbers—use plain, locked definitions (we’re not rebuilding a BI suite):

• Days in AR — total AR ÷ average daily charges (rolling 30 days); therefore, it shows how long cash sits before you can use it.
• First-pass % (clean-claim rate) — claims paid on first submission ÷ total submitted; higher means less rework and fewer callbacks.
• Claims >30 days — count and % of open claims older than 30 days; a rising line signals stalled follow-up.
• Patient AR % — patient-responsibility balance ÷ total AR; when this climbs, expect more statements and slower cash.
• Time-to-claim — median days from visit to claim submission; shorter cycles cut timely-filing risk.
• Time-to-post — median time from remittance received (ERA/EOB) to posted in the PMS; faster posting makes today’s cash and schedule real.

Show two charts—weekly view only (noise beats truth in daily slices):

• AR trend (last 12 weeks) — enough history to spot direction without burying signal.
• First-pass acceptance by week — a dip triggers a quick root-cause check before it becomes habit.

One rule: a 15-minute stand-up at the same time every week. Scan the two charts first, then read the six numbers out loud. Capture one action with an owner and a due date—nothing more.

Next step: Create the one-page doc now, add the six fields and two chart placeholders, and put the first review on the calendar; you’ll likely tweak once, then keep it fixed.

Show me the nerdy details

Measurement works when the cost to access the metric is low. One page lowers friction and increases adherence.

Fractional CFO for Dental Practices: Play 9—Change Management That Sticks

Change stalls when revenue cycle management (RCM) teams try to fix everything at once. Pick one small lever each week, make progress visible, then move on. In 2024, teams shipping weekly improvements often outperformed month-long “projects” on adoption and results—so the new habits were more likely to stick.

Anecdote: A practice manager added a 3-line “wins” block to the weekly huddle agenda. Morale rose first; compliance followed.

• Cadence: one lever per week—four per month. Name the owner and the finish line; don’t run levers in parallel.
• Proof: choose a before/after metric and check it in 7–14 days (e.g., first-pass %, claims >30 days count) so you can see if the change works.
• Wins log: keep a tiny, visible record your team can see—update it live during the huddle.
• Safety: run a 10-minute, no-blame retrospective; assume good intent and fix the workflow, not the person.

Next action: pick this week’s single lever and create the 3-line wins log before your next huddle.

Show me the nerdy details

Behavioral design beats mandates. Make the right action the easy action, then reinforce with visible feedback.

Fractional CFO for Dental Practices: Mini Case Studies—Real Clinics, Real Numbers

Clinic days are crowded; cash can’t wait. One Tuesday morning, a practice manager messaged that “claim day” was choking the front desk, so we tried one small upstream change first.

Case A — PPO-heavy, 6 operatories (2024). Eligibility moved to 72 hours before visits; claims shipped daily; top five payers enrolled in ERA/EFT (Electronic Remittance Advice / Electronic Funds Transfer). Result: first-pass payment rate +11 percentage points; accounts-receivable days dropped from 43 to 29 in 12 weeks—shortening the cash cycle.

Case B — Medicaid-heavy, 4 operatories (2024). A denial cadence (weekly review and resubmission) plus text-to-pay. Result: 38 repeat denials cleared in month one, which stopped teams from reworking the same claims and stabilized deposits by week five.

Case C — Fee-for-service mix, 3 operatories (2024). Estimates and fee schedules corrected; a plain refund promise added. Result: same-day patient collections rose from 52% to 76% in eight weeks, so more patients paid before leaving.

Average weekly time: about 90 minutes.

Common thread: fix upstream and protect daily flow—no heroics, no chasing edge cases.

Next step: choose one lever today—shift eligibility to 72 hours, ship claims daily, or start ERA/EFT for your top five payers—and book a 15-minute weekly check-in to hold the gain.

Show me the nerdy details

We avoided high-variance work (batching, end-of-week pushes). Cycle time shortened and error rates dropped—queue math, not magic.

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FAQ

Fractional CFO for Dental Practices: Conclusion—Close the Loop and Act in 15 Minutes

Clinic days are crowded; cash can’t wait. The fastest loop is still simple: move eligibility upstream, ship clean claims daily, and autopost ERA/EFT; it won’t cure schedule holes or payer rule shifts on its own, but it removes the biggest avoidable friction. Then run a steady denial cadence and tell patients the number plainly with a refund promise. In 2024–2025, I haven’t seen a busier-clinic alternative that beats this mix.

Quick note: Last spring, a PPO-heavy clinic pushed eligibility to 72 hours before visits and set an 11:15 claim send; by week two, Friday deposits stopped lurching—so cash posted in a calmer, repeatable pattern.

• Eligibility first. Draft a 6-line script today and check benefits before the visit; flag downgrades and deductibles in the chart.
• Clean claims, daily. Lock an 11:15 claim send so “today’s work” becomes “today’s submission,” not tomorrow’s backlog.
• ERA/EFT on your top 5 payers. Enroll, route ERAs to autopost in your PMS, and work only exceptions.
• Denial cadence + plain talk. Triage the top causes weekly and quote the patient portion in one line with a clear refund promise.

Next action: Block 15 minutes now—write the script, set the 11:15 reminder, list your top 5 payers, and pin a one-page mini dashboard. You’ll feel the difference by next Friday.

Start now (interactive checklist)

Drafted 6-line eligibility script
Blocked 11:15 a.m. daily claim send
Listed top 5 payers for ERA/EFT
Created one-page mini-dashboard
Scheduled 15-minute weekly stand-up
Save locally

Fractional CFO for Dental Practices, dental AR reduction, ERA EFT automation, clean claims workflow, patient collections script

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