Apex Reimbursement Specialists

Apex Reimbursement Specialists is a dental practice revenue cycle and practice management consulting firm.

[Apex Reimbursement Specialists @ApexReimburse]

InsideDesk raised $12.6M for AI revenue cycle tools. AAE urges caution on AI in insurance decisions. Speed helps only when the decision is right.

Who reviews the claims decisions in your practice?

https://t.co/LI1o4hmUw5

[Apex Reimbursement Specialists @ApexReimburse]

Your fee schedule and what each payer pays are two different numbers. Compare contracted rates to UCR on your top 10 codes.

Which code would surprise you most?

[Apex Reimbursement Specialists @ApexReimburse]

Pull each payer's allowed amount and your UCR for your top 10 codes and compare. It takes about three minutes.

Which of your top ten codes have you never compared?

[Apex Reimbursement Specialists @ApexReimburse]

You can't keep raising hygienist wages on reimbursement rates signed years ago. Apex averages a 7-10% increase across about 5,000 practices.

When did your fee schedule last keep up with your payroll?

https://t.co/LI1o4hmUw5

[Apex Reimbursement Specialists @ApexReimburse]

Federal fraud enforcement is stepping up and dental offices are on the radar. Try a ten-chart self-audit for upcoding, unbundling, and missing documentation.

What would an auditor find in yours?

[Apex Reimbursement Specialists @ApexReimburse]

Federal fraud scrutiny now includes dental offices. Five red flags: upcoding, downcoding patterns, unbundling, missing documentation, waived copays.

Which would an audit find in your charts?

[Apex Reimbursement Specialists @ApexReimburse]

A proposed antitrust class action has been filed against Delta Dental of Washington (Becker's). The complaint makes allegations; nothing has been decided.

Do you have your own reimbursement data on file?

https://t.co/LI1o4hmUw5

[Apex Reimbursement Specialists @ApexReimburse]

Heartland Dental added Foundation Dental Partners' 33 practices (Becker's). A payer knows which request carries more volume.

What gives your practice leverage?

[Apex Reimbursement Specialists @ApexReimburse]

Heartland Dental added Foundation Dental Partners' 33 practices (Becker's). Bigger groups bring more volume to payer negotiations.

Who negotiates for your independent practice?

[Apex Reimbursement Specialists @ApexReimburse]

Massachusetts ordered $8.4 million in dental insurance rebates (DrBicuspid). Regulators are now measuring what payers keep.

Do you know what loss ratio each of your payers is held to?

https://t.co/LI1o4hmUw5

[Apex Reimbursement Specialists @ApexReimburse]

California's AB 1629 now requires dental plans to honor assignment of benefits (DrBicuspid), so payment can go straight to your practice.

Do you know which of this year's 21 new state laws apply to you?

[Apex Reimbursement Specialists @ApexReimburse]

14 states enacted 21 dental insurance reform laws in 2026 (Becker's). California's AB 1629 now requires plans to honor assignment of benefits.

Do you know which apply in your state?

[Apex Reimbursement Specialists @ApexReimburse]

About 23% of dentists have dropped an insurer in 2026 (ADA, via Becker's). Before you drop one, compare lost patients against a renegotiated fee schedule.

Have you put a number on what leaving would cost?

https://t.co/LI1o4hmUw5

[Apex Reimbursement Specialists @ApexReimburse]

$15 a week on paper checks (Delta Dental of California, per ADA News) is $780 a year for the same payment.

Which of your payers still send paper checks?

[Apex Reimbursement Specialists @ApexReimburse]

Delta Dental of California now charges $15 a week for paper-check payments (ADA News). If it applies every week, that is $780 a year.

Which of your payers still pay you by paper check?

[Apex Reimbursement Specialists @ApexReimburse]

PDS Health opened 10 offices in one month and now has 1,100+ (Group Dentistry Now). DSOs bring volume and data to payers. Apex brings independents $1B+ in negotiating experience.

Who reviews your payer contracts?

https://t.co/LI1o4hmUw5

[Apex Reimbursement Specialists @ApexReimburse]

With three insurers at a median 66.8% market share (GAO), competition between payers won't raise your fees. Comparable-practice data can.

How does your fee schedule compare to practices like yours?

[Apex Reimbursement Specialists @ApexReimburse]

The three largest dental insurers hold a median 66.8% market share (GAO). Most practices walk into a fee negotiation with no data.

Does a solo practice have any negotiating power?

[Apex Reimbursement Specialists @ApexReimburse]

Nearly 80% of practices report more denials or payer scrutiny over the past year (Zentist via Becker's). The cause is usually a process gap you can fix.

Which payer drove most of your denials last quarter?

https://t.co/LI1o4hmUw5

[Apex Reimbursement Specialists @ApexReimburse]

A dental loss ratio is the share of premium spent on patient care. Massachusetts requires 83% and ordered six insurers to return $8.4M. A payer with more margin has more room on your fees.

What would your payers' ratios say about your next request?