As of August 2026, the economics of running a dental practice in Canada are tighter than at any point in the past decade. Staff costs are rising, supply inflation persists, and the Canadian Dental Care Program (CDCP) has introduced new billing complexity for practices that opt in. Against this backdrop, one of the highest-leverage financial improvements most practice owners can make is also one of the least glamorous: getting better at collecting the money they have already earned.
Accounts receivable — the total amount owed to your practice by patients, insurance carriers, and government programs — is not a filing cabinet problem. It is a cash flow problem with compounding consequences. Every dollar that sits in AR for 60, 90, or 120+ days costs your practice twice: once in the time value of money, and again in the administrative cost of chasing it down.
The AR Benchmarks That Matter for Canadian Dental Practices
Before you can improve your collections, you need to know where you stand. The following benchmarks represent the targets for well-managed dental practices in Ontario and across Canada:
- Collection ratio: 98% or higher (net collections divided by net production). If your ratio is below 95%, you are leaving significant revenue on the table.
- AR over 60 days: Less than 15% of total AR. Anything above 20% indicates a systemic billing or follow-up problem.
- AR over 90 days: Less than 3% of total AR. Balances older than 90 days are statistically unlikely to be collected without aggressive intervention, and many never will be.
- Insurance claim turnaround: 14-21 days from submission to payment for clean claims. If your average is over 30 days, you likely have claim submission errors or are not following up on pending claims frequently enough.
- Patient balance collection rate: 95% or higher at time of service. Collecting copays and deductibles at the appointment is dramatically more effective than billing patients after the fact.
Pro Tip: Run your AR aging report right now. If you do not know your current over-90-day percentage off the top of your head, that is itself a diagnostic finding — it means AR is not being reviewed systematically.
The Weekly AR Review: The Single Highest-Impact Habit
The most effective practice owners and office managers in Canada share one habit: they review their AR aging report every week. Not monthly. Not quarterly. Weekly.
A weekly AR review takes 30-45 minutes and should follow this structure:
- Generate the aging report from your practice management software (Abel, Dentrix, or ClearDent are the most common in Ontario). Sort by aging bucket: 0-30, 31-60, 61-90, and 90+ days.
- Start with the 90+ day bucket. For each account, make one of three decisions: submit a final demand, send to collections, or write off. Do not let accounts sit in 90+ indefinitely — they are clogging your report and making it harder to spot the actionable items.
- Work the 61-90 day bucket. Every account here should have at least one documented follow-up attempt. If not, that is today's action item.
- Scan the 31-60 day bucket for insurance claims. Any insurance claim older than 30 days without payment or denial should be traced. Call the carrier if necessary — most Canadian dental insurance carriers have provider hotlines specifically for claim status inquiries.
- Review the 0-30 day bucket for volume and trend. This bucket should be growing relative to the others. If your 0-30 bucket is shrinking while 31-60 is growing, claims are not being submitted promptly.
Pro Tip: Assign a specific team member to own the weekly AR review. Do not let it rotate or become an "everyone's responsibility" task — which in practice means no one's responsibility. One person, same day each week, documented results.
Insurance Claim Management: Where Most Canadian Practices Lose Money
For the average Canadian dental practice, insurance claims represent 50-70% of total collections. This makes insurance AR management the single largest lever in your collections performance.
Submit Clean Claims on Day One
The most expensive insurance AR problem is also the most preventable: submitting claims with errors that trigger denials or requests for additional information. Common errors in Canadian dental insurance claims include:
- Incorrect procedure codes (Canadian Dental Association fee guide codes are updated annually — ensure your PMS is current)
- Missing or incorrect subscriber information
- Failing to include required radiographs or narratives for procedures that commonly require predetermination (crowns, endodontics, periodontal surgery)
- Incorrect provider number — particularly in group practices where associates bill under their own RCDSO registration number
Every claim that is denied or returned for additional information adds 15-45 days to your payment cycle and costs your admin team 10-20 minutes in rework time. Across hundreds of claims per month, this adds up to a measurable drag on your practice's cash flow and administrative overhead.
Predetermination Strategy
For major restorative and surgical procedures, Canadian dental insurers routinely require predetermination. The smartest practices build this into their scheduling workflow: when a treatment plan exceeds the predetermination threshold (typically $300-500 CAD depending on the carrier), the predetermination is submitted the same day the treatment plan is presented, not when the patient is finally scheduled.
This approach shortens the time between treatment plan acceptance and payment by the full duration of the predetermination review — often 2-4 weeks. For a practice scheduling major work 6-8 weeks out, this means the predetermination is approved before the appointment, not pending during the collections cycle after.
Patient Balance Collection: The Time-of-Service Principle
The single most effective patient collections strategy is the simplest: collect the patient's estimated portion at the time of service, before they leave the chair.
For practices that still bill patients after insurance payment, the economics are stark. Patient statements cost $2-5 CAD each to produce and mail. A typical practice sends 2-3 statements before a patient pays, and a meaningful percentage never pay at all. The follow-up phone calls cost additional staff time. By contrast, collecting at time of service costs nothing beyond the 30 seconds it takes to process the payment.
Building a Time-of-Service Collection Protocol
- Verify insurance benefits before every appointment. Know the patient's copay percentage, annual maximum remaining, and any deductible balance before they arrive.
- Quote the estimated patient portion when confirming the appointment. This sets the expectation that payment is due at the visit, not after.
- Collect at checkout. Train your front desk team to present the estimated amount confidently and process payment as a routine part of the checkout flow — not as an awkward afterthought.
- Handle the balance when the insurance explanation of benefits arrives. If the actual patient portion differs from the estimate, send one statement for the difference or issue a credit immediately.
Pro Tip: If your time-of-service collection rate is below 85%, the problem is usually not patients refusing to pay — it is your front desk team not asking. Role-play the checkout conversation in a team meeting. The specific language matters: "Your estimated portion today is $147 — would you like to use the card we have on file?" is more effective than "Do you want to pay anything today?"
CDCP Claims: New AR Complexity for Ontario Practices
The Canadian Dental Care Program (CDCP) has added a new layer of billing complexity for participating Ontario dental practices. CDCP claims are processed through Sun Life, and the reimbursement rates follow a modified version of the provincial fee guide. Practices that have opted in should be aware of several AR implications:
- Preauthorization delays: Many CDCP procedures require preauthorization, which adds processing time before treatment can begin. Build this into your scheduling and AR forecasting.
- Benefit year resets: The 2026-2027 CDCP benefit year began July 1. Ensure your team is submitting claims against the current benefit period and is aware of any carryover limitations.
- Patient copay responsibility: CDCP does not cover 100% of all procedures for all income levels. Patients may owe a copay, and collecting it is the practice's responsibility — Sun Life will not pursue it.
When to Send Accounts to Collections
No practice owner enjoys sending patient accounts to a collections agency, but delaying this decision has a real cost. The probability of collecting on an account drops steeply with age:
- 90 days: approximately 70-80% probability of collection
- 120 days: approximately 50-60%
- 180 days: approximately 25-35%
- 365 days: below 15%
Most Canadian dental practices should have a clear, documented policy: patient accounts with no payment activity for 120 days are sent to the collections agency. Make one final contact attempt (phone and written notice) at 90 days, clearly stating that the account will be referred to collections if not resolved within 30 days. Then follow through.
When selecting a collections agency, look for one experienced with dental and healthcare accounts in Ontario. The agency's fee (typically 25-40% of collected amounts) is the cost of recovering money you would otherwise write off entirely.
Technology That Actually Helps
Dental-specific practice management software in Canada (Abel, Dentrix, ClearDent, Tracker) all include AR aging reports, automated statement generation, and insurance claim tracking. The features are there — the question is whether your team is actually using them.
Three technology investments that produce measurable AR improvements:
- Automated insurance eligibility verification: Services that check patient insurance status in real time, before the appointment, reduce claim denials due to coverage issues.
- Electronic claim submission: If you are still mailing paper claims for any reason, stop. Electronic submission through CDAnet or direct carrier portals cuts submission-to-payment time by 7-14 days on average.
- Patient payment portals: Online payment options let patients pay outstanding balances on their own time. For practices that implement them, patient balance collection rates typically improve 5-10%.
The AR Dashboard: Three Numbers to Watch Every Week
You do not need a complex financial dashboard to manage AR effectively. Track three numbers weekly:
- Total AR as a percentage of monthly production. This should be 1.0-1.5x your average monthly production. If it is above 2.0x, you are carrying too much outstanding revenue.
- Over-90-day AR as a percentage of total AR. Target: below 3%. If it is above 5%, schedule a dedicated session to clean out old balances.
- Collection ratio (trailing 3 months). Target: 98%+. Calculate as: (total payments received / total production) x 100, adjusted for write-offs and contractual adjustments.
Post these three numbers where your office manager and billing team can see them. Visibility drives accountability.
Frequently Asked Questions
Q: What is a normal collection ratio for a dental practice in Ontario?
Well-managed dental practices in Ontario typically achieve a 97-99% collection ratio. The provincial average sits closer to 93-95%. The gap — 3-5 percentage points — represents tens of thousands of dollars in annual revenue for a practice producing $1 million or more per year. Closing this gap is one of the highest-return activities a practice owner can pursue.
Q: How do I handle patients who refuse to pay their copay or deductible?
Under most Canadian dental insurance plans, the patient is contractually responsible for any amount the insurer does not cover. You are not required to waive copays, and doing so routinely can be considered insurance fraud if the insurer is led to believe they are paying a percentage of a higher amount than the patient actually owed. Have a clear financial policy that patients sign, include payment expectations in your appointment confirmations, and be consistent in collecting at time of service.
Q: Should I offer payment plans for large treatment amounts?
Yes, but with structure. For treatment plans above $1,500-2,000 CAD, offering an in-house payment plan (or partnering with a third-party financing provider) significantly increases case acceptance. Structure the plan with automatic payments and a clear term — 3, 6, or 12 months. Do not offer open-ended "pay when you can" arrangements, which default at high rates and create ongoing AR management burden.
Improving your accounts receivable is not a one-time project — it is a permanent operating discipline. The practices in the Greater Toronto Area and across Ontario that consistently maintain 98%+ collection ratios do so because they built the systems and habits described above and never stopped doing them. Start with the weekly AR review this week. The revenue you recover will compound.
For more practice management insights for Canadian dental professionals, visit ebiko.ca.