By Alvin T. Uta’i, Founder & CEO of Elite Dental Force
Originally published at Elite Dental Force Blog
Reposted with permission.

If you run a dental practice, you’ve likely faced the frustration of reviewing monthly numbers and seeing your first-pass claim approval rate stagnate at 75%. It’s a tough pill to swallow, especially when everyone says the “industry standard” should be closer to 95%. Yet, even after investing in new systems or staff development, genuine progress is elusive. Sound familiar? You’re not alone, and it turns out the issue may go deeper than your team’s performance or even your software.

Each year, dental practices across the United States lose more than $16 billion, almost 10% of all revenue, from completed, billable treatments that never get paid. This loss doesn’t come down to a few simple mistakes. Instead, it points to widespread shortcomings in the way our profession manages and shares critical billing data. Many of the benchmarks we work so hard to achieve aren’t as trustworthy as we might hope, and understanding why makes all the difference.

Why Industry Metrics Can’t Always Be Trusted

For as long as anyone can remember, practices have looked to industry benchmarks for guidance. But the reality is, universal metrics like first-pass claim approval rates are almost impossible to verify with any real accuracy. That’s because the back-end connections between practices and insurers are filled with inconsistencies.

A few of the biggest problems include:
● Incomplete Benefit Info at the Start: Roughly 30% of practices can’t get accurate insurance eligibility information before work begins. That means crucial treatment and financial decisions often start off on shaky ground.
● Aging EDI Technology: The Electronic Data Interchange tools meant to help practices communicate with payers are lagging behind. Most still can’t confirm benefits in real time. In many cases, the best you’ll get is a generic “benefits may apply” note, not much help when you need concretes.
● Every Payer Speaks a Different Language: One insurance plan will stick to standardized CDT codes, another prefers vague, boilerplate descriptions, and some skip important details altogether. The result? Reliable, apples-to-apples comparisons are nearly impossible.
● Errors Are Everywhere: Nearly 4 in 5 dental bills contain some kind of mistake. This steady flow of incorrect info clouds your real financial picture, so much so that about 80% of practices worry about money because of coding and billing headaches.

So if you’re not hitting the “magic number,” it doesn’t automatically signal that you or your team have failed. In many cases, the problem is that the goalposts themselves aren’t as firm as they seem.

The Many Ways Bad Data Hurts Practices

That $16 billion in lost income is only one part of the story. Flawed or outdated billing data seeps into every layer of practice operations, often in ways that are felt more than they’re measured. These aren’t abstract problems, they play out daily as inefficiency, fatigue, and lost trust.

Consider the following:
● Mistakes in Business Planning: Whether you’re deciding who to hire, which treatments to focus on, or how to budget for technology, every big choice is harder and riskier if your numbers are unreliable.
● Team Morale Takes a Hit: Staff members waste hours chasing fuzzy insurance answers, fixing denied claims, and smoothing things over when patients are surprised by what they owe. Over time, it wears people down.
● Patient-Provider Relationship Suffers: Few things frustrate patients more than being hit with unexpected bills because those bills were built on shaky estimates.

Without dependable data, leaders can’t truly gauge performance or figure out where to focus improvements.

How to Create Reliable Numbers of Your Own

Given all these issues, what should a practice do? The answer is to shift inward: build and measure your own data, rather than chasing someone else’s idea of “average.” Focus on actionable results, not abstract ideals.

Here’s how to start:
● Find Your Own Baseline: Identify key metrics that reflect your real-world workflow, like your practice’s actual first-pass claim rate, average days outstanding, and the portion of claims needing manual fixes. This is your reference point.
● Watch Internal Progress: Track important numbers over time with regular (monthly) reports that capture what’s really happening with your own payer mix and team. Are claim denials dropping? Are collection times improving? These trends are what matter.
● Strengthen Your Billing Process: Proactively incorporate checks at each step. For example, use a dual-review for complex or high-value claims, and standardize info-gathering at patient intake.
● Do Your Homework with Tech Solutions: When evaluating a new software platform, don’t settle for flashy marketing. Ask deep questions about reporting, automation, and most importantly, results seen by practices similar to yours.
● Choose Tools That Prevent Issues Early: Prioritize technology that checks for errors before anything is sent off to payers, rather than simply alerting you once a denial comes through.

The Bigger Picture: What the Industry Can Do

Of course, fixing your own processes is just one piece of the puzzle. There’s a pressing need for industry-wide changes to ensure accuracy and fairness for all practices and patients.

Some priorities:
● Universal Reporting Standards: Insurers and clearinghouses should collaborate on clear, consistent formats so practices are all working from the same data sets.
● Real-Time, Reliable Verification: Dental teams deserve to know in advance exactly what’s covered, with minimal ambiguity.
● Independent, Transparent Benchmarks: We need more open, third-party research, based on broad data samples, to help the profession set honest expectations.
● Integrated Workflow Tools: From front-desk to claim submission, every system (practice management, clearinghouse, payer portal) needs to work together as seamlessly as possible to limit manual entries and data mismatches.

Shifting the focus from chasing unreliable industry benchmarks to maintaining and trusting your practice’s own data can help create healthier, more resilient business models. In the end, more accurate data benefits not only your team and bottom line but also the patients who rely on you for care and honest communication.