🇺🇸United States

Inconsistent Treatment Planning Leading to Low Case Acceptance

1 verified sources

Definition

Provider variation in treatment planning causes conflicting recommendations for the same patient, resulting in unpredictable case acceptance rates and lost revenue from unaccepted treatments. Practices suffer from missed opportunities as patients decline plans due to confusion or perceived inconsistencies. This systemic issue reduces overall production as not all diagnosed services are billed or upsold effectively.[3]

Key Findings

  • Financial Impact: $Varies by practice; significant revenue loss from unpredictable acceptance rates
  • Frequency: Ongoing in practices without standardized protocols
  • Root Cause: Lack of consistent, evidence-based treatment planning protocols leading to subjective variations between providers

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Dentists.

Affected Stakeholders

Dentists, Treatment Coordinators, Practice Owners

Deep Analysis (Premium)

Financial Impact

$10,000-$35,000 annually from VA surgical case delays/denials; Surgeon's time on VA coordination • $10,000-$40,000 annually from surgical case authorization delays; Surgeon's time on coordination • $10,000-$40,000 annually from VA case rejections; Coordinator's time on manual VA verification

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Current Workarounds

Each provider and assistant informally builds their own version of the plan using memory, paper notes, ad‑hoc templates in the PMS, and spreadsheets or printed fee sheets to quote options and stage treatment. • Email threads to clarify plans, manual follow-up calls to patients, ad-hoc case summaries, spreadsheet tracking of plan versions • Informal verbal communication, handwritten treatment notes, memory-based recommendations, ad-hoc email threads, no standardized presentation template

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Poor Case Presentation Causing Treatment Plan Rejection

$Lost production from declined cases; practices report low acceptance rates

Sequencing Errors Delaying Treatment Execution

$Opportunity cost from delayed billable procedures and rework

Subjective Treatment Recommendations Without Standardized Protocols

$Wasted investments in ineffective treatments and lost efficiency

Revenue loss from CDT coding errors and claim denials

Common denial/underpayment rates of 5–15% of dental claims are reported in billing industry benchmarks; for a $1M/year practice this implies $50,000–$150,000/year in at-risk revenue, with a material portion written off when denials are not worked (estimates based on billing industry norms and insurer denial patterns, not a single study).

Lost revenue from incomplete or missing CDT-coded claim data

Payers commonly impose 6–12 month filing limits; recurring resubmission failures in busy practices can easily forfeit several thousand dollars per month in older, uncorrected claims once the filing window closes (derived from payer policies and typical claim volumes).

Operational cost from repeated claim corrections and resubmissions

For a typical practice submitting hundreds of claims per month, dedicating even 0.25–0.5 FTE just to fix preventable CDT‑related issues represents roughly $10,000–$25,000/year in extra labor costs (based on common US dental billing wage levels and claim volumes).

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