Dental Service Organization Playbook

Why: Every day a provider is un-credentialed with a major payer costs $800-$2,400 in unbillable production. How: Pull every provider's CAQH profile, every payer contract, every credentialing application status. Build a matrix: provider × payer × status (in-network, out-of-network, application pending). Done: one-page matrix dated this week. Pitfall: trusting the seller's word that 'we take all major insurance' without verifying each provider individually. (Dodson, 'Set the Right Priorities': cash-flow-critical items go first.)

Why: Credentialing follows the Tax ID, not the practice location. A sale usually triggers re-credentialing across every payer and every provider. How: Use a credentialing service (Apex, Medallion, or in-house coordinator). Prioritize top-5 payers by revenue first. Track each application through PECOS, CAQH, and individual payer portals. Done: applications filed for 100% of providers with top-5 payers within 3 weeks of close. Pitfall: batching all payers equally. The 80/20 on revenue is extreme in dental — top 2-3 payers usually drive 60-70% of revenue.

Why: Fee schedules haven't been renegotiated in years at most acquired practices. A 3-5% uplift across the book drops straight to EBITDA. How: Pull 24 months of claims data by payer, benchmark against regional averages (ADA publishes survey data). Approach payers with specific procedure codes where you're below market. Done: 3 negotiation packets sent; one uplift won. Pitfall: asking for an across-the-board increase. Payers say no. Target specific underpriced codes with data.

Why: Dental AR >60 days is where margin goes to die. Collection rates drop 2% per 30-day bucket after day 60. How: Standing 30-minute monthly review with CFO / billing lead on the 15th. Pull aging report, review every account >$500 and >60 days, assign owner for next 30 days. Done: recurring calendar hold + template tracker. Pitfall: letting the office manager run it without CEO attention — it becomes reactive rather than preventive.

Why: Roll-ups often arrive with 2-5 different PMS systems (Dentrix, Eaglesoft, Open Dental, Denticon, Curve). Each is its own data silo. How: For each site: PMS name, version, data hosting (local vs cloud), monthly fee, number of seats, imaging software, payer eligibility tool. Document in a single spreadsheet. Done: one-page system map. Pitfall: assuming newer = better. Local-installed Dentrix often outperforms cloud tools on reliability if you have IT support.

Why: Standardizing on one PMS unlocks cross-site analytics, centralized scheduling, and consolidated billing. How: Score each candidate on: cloud-native, open API, scheduling features, claim submission, reporting depth, customer support, per-seat cost. Pilot at the weakest current site first. Done: migration plan + pilot site selected. Pitfall: migrating during a busy season. Schedule migrations in Q1 or late summer when volume is lower.

Why: You cannot manage what you cannot see. A daily/weekly dashboard of production, collection, new patients, hygiene pre-appointment rate across all sites is the foundation of multi-site management. How: Direct SQL to the PMS (if supported) or ETL to a warehouse. Metabase or Looker for dashboards. Done: a single dashboard link every site manager checks Monday morning. Pitfall: letting PMS-native reports suffice. They're inconsistent across locations and don't roll up.

Why: Without a standing agenda, the weekly call becomes status updates and anecdotes. The L10 format forces accountability. How: Segue (5 min), Scorecard (5), Rock review (5), Customer/employee headlines (5), To-Do review (5), Issues / IDS (60), Conclude (5). 90 min total. Send the template to site managers 48 hours before the first meeting. Done: template in everyone's inbox. Pitfall: running the first meeting without the template. The first meeting sets the tone. (Dodson, 'Become Great at Meetings': the L10 is the operating system.)

Why: The score forces the team to own the quality of the meeting. Average scores week 1 are 4-5. By week 12, they should be 7-8. How: Last 2 minutes of every L10, go around and each person rates the meeting 1-10 with one sentence on why. Aggregate scores week over week. Done: first L10 held; scores logged. Pitfall: accepting excuses for missing the meeting. Cadence > content. Protect it like a board meeting.

Why: Recare (patients returning every 6 months) is the single largest lever in dental economics. Industry average is ~50%; best-in-class is 75%+. Every 5% improvement drops straight to EBITDA. How: Pull last 18 months of hygiene appointments by patient. Calculate: % of patients with a completed hygiene appointment who had another within 7-9 months. Break down by provider and by site. Done: baseline recare rate by site and provider. Pitfall: using 6-month windows. Patients slip; 7-9 months captures actual behavior.

Why: Patients who book their next appointment at checkout have a 3x recare rate vs those who 'get a call later.' How: Train every front desk to ask 'Let's book your next hygiene now' before the patient leaves. Use PMS's recall scheduler. Script: 'Dr. X wants to see you back in 6 months. Does Tuesday afternoon work for you that week?' Done: pre-appointment rate >70% across all sites. Pitfall: making it optional. This is a required checkout step, not a suggestion.

Why: No-show and same-day cancel rates cost a typical practice 8-12% of capacity. Automated reminders cut this in half. How: Enable PMS reminders or layer a tool like Weave / Solutionreach / Dental Intel. Two reminders (48h and 24h before) plus a 'we miss you' text at 9 and 12 months post-visit for no-shows. Done: reminders firing, tracked no-show rate trending down. Pitfall: over-texting. 2-3 touches per appointment maximum.

Why: Most dental acquisitions fail at the middle layer. The office managers who were great at 1 location break at 3+. You need someone between the CEO and site-level OMs. How: Define the seat's mission (one sentence), outcomes (5-7 measurable), and competencies (leadership, dental ops experience, analytical). Don't write a JD — write a scorecard. Done: one-page scorecard. Pitfall: hiring the best current OM into the role. Running one vs coaching five are different jobs.

Why: The pool is small and reputation-driven. Posting on LinkedIn gets you unqualified applicants. How: Reach out to dental recruiting specialists (DSO Strategy, IDSO), your ADA peer network, and LinkedIn search for 'Director of Operations' at regional DSOs. Aim for 3 active interviews / week. Done: pipeline of 8+ qualified candidates. Pitfall: hiring from a competing DSO without checking non-competes. Dental is litigious here.

Why: The Topgrading chronological interview (2-3 hours, walking through every job in order) is the single highest-ROI hiring practice in SMB. How: For each role in their history, ask: what were you hired to do, what did you accomplish, what were your failures, who was your boss, how would they rate you 1-10 and why. Done: 3 candidates through full Topgrading; offer made. Pitfall: skipping references. Always do 3 references per candidate on your top-2 finalists.