You might think your practice is doing “everything right,” but chances are—even if unknowingly—you’re making at least one of these five compliance-risk mistakes every day. Catching them early prevents audits, fines, and reputational headaches.

1) Billing services under the wrong provider

Sometimes a doctor will perform a service, but the billing gets assigned to a different provider—often because one is in-network or credentialed while the other is not. That might seem harmless, but it’s not. Insurance companies expect the rendering provider (the dentist or clinician who actually performed the work) to appear on the claim.

Pro Tip:  Billing under the wrong provider is one of the fastest ways to trigger an audit.

2) Charging for radiographs of poor diagnostic quality

Radiographs (like bitewings, periapical films) that are overlapped, fuzzy, or otherwise fail to capture the anatomy are not valid for billing. If the image doesn’t meet diagnostic standard, it doesn’t meet justification for charge.

Pro Tip:  If you can’t diagnose from it—you can’t bill for it.

3) Taking insurance as “payment in full” or writing off patient portions

If you accept insurance payment as “payment in full” in cases where the patient’s contract actually requires a portion due from them, you’re violating terms. Even worse, writing off employee patient portions just because “they work here” is still not allowed.

Pro Tip:  Convenience is not compliance—patient cost shares cannot be waived without cause.

4) Failing to bill insurance for services

Skipping insurance billing because a patient wants to pay cash, because you expect a denial, or to bundle services into one flat fee is a compliance landmine.

Pro Tip: You cannot legally skip billing insurance just to make things easier.

5) Letting credit balances linger

Credit balances—whether from overpayments or adjustments—belong to the patient. Many states require you to return them promptly or send them to unclaimed property divisions.

Pro Tip:  Unreturned credit balances aren’t “extra cash”—they’re liabilities waiting to be discovered.

Why these matter

Regulators and payers are increasingly scrutinizing dental practices and DSOs for billing integrity and adherence to contracts. Errors—even “small” ones—can escalate to large fines or forced repayments. A robust compliance culture doesn’t just protect you; it strengthens patient trust and stabilizes cash flow.

What your next steps should be

• Run a quick “billing audit” by matching a random week of claims to rendered services and images.

• Train your team to reject and retake substandard radiographs before submission.

• Confirm you’re applying patient responsibility consistently.

• Default to billing insurance unless there is a documented, allowable exception.

• Reconcile and refund credit balances on a set schedule.