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Understanding the IRS Math and Taxpayer Help Act

If you’ve ever received an IRS notice claiming there was a “math error” on your tax return—only to be left scratching your head about what actually went wrong—you’re not alone. For years, dental practice owners and other taxpayers have been frustrated by vague IRS notices that provide little explanation and even less guidance on how to respond.

That’s about to change.

What Is the IRS MATH Act?

On December 1, 2025, President Trump signed the Internal Revenue Service Math and Taxpayer Help Act (IRS MATH Act) into law. This bipartisan legislation passed unanimously in both the House and Senate, reflecting broad agreement that taxpayers deserve straightforward, transparent communication from the IRS.

The law, which takes effect on December 1, 2026, requires the IRS to provide specific, detailed explanations when it adjusts a tax return for a mathematical or clerical error. No more guessing games about what triggered the change or how much you owe.

What Changes Under the New Law?

When the IRS MATH Act goes into effect, math error notices must include:

Plain language explanations. The IRS must describe the error clearly, including the specific Internal Revenue Code section and the exact line on your tax return where the issue occurred.

Itemized calculations. You’ll receive a detailed breakdown showing exactly how the IRS computed the proposed adjustment and how it affects your return.

Prominent deadlines. The 60-day window to challenge the adjustment must appear in bold on the first page of the notice. This is critical because failing to respond within this timeframe typically means losing your right to contest the assessment in U.S. Tax Court.

Clear response procedures. The notice must explain how you can request an abatement—whether in writing, electronically, by phone, or in person.

Specific error identification. The IRS can no longer send you a list of possible errors. They must identify the exact issue on your return.

The law also establishes a pilot program to test whether sending these notices by certified mail improves delivery and response rates.

Why This Matters for Your Dental Practice

Math error notices are more common than many practice owners realize. According to IRS data, over one million of these notices were sent during the 2023 tax year alone. For busy dental professionals managing patient care, staff, and business operations, receiving a confusing IRS notice can be stressful and time-consuming.

Under the old system, many taxpayers simply accepted the IRS adjustment because they couldn’t figure out what had gone wrong or didn’t realize they had a limited window to respond. The IRS MATH Act levels the playing field by giving you the information you need to understand the situation and make an informed decision about whether to challenge it.

What Should You Do Now?

While this law won’t take effect until late 2026, here’s what you can do in the meantime:
If you receive a math error notice before the new rules take effect, review it carefully and contact your tax advisor promptly. Remember that you typically have only 60 days to dispute the assessment. Keep thorough records of all tax return documentation, which will make it easier to respond to any IRS inquiries. If you’re having difficulty resolving an IRS issue, the Taxpayer Advocate Service (TAS) is a resource that can help you navigate the process.

We’re Here to Help

At Dental Accounting Group, we monitor tax law changes that affect dental practices so you can focus on what you do best—caring for your patients. If you receive an IRS notice or have questions about how tax changes might affect your practice, our team is ready to assist.

Sources:

Disclaimer: This article is intended for general informational purposes only and does not constitute legal, tax, or professional advice. Every situation is unique, and tax laws are subject to change. You should consult with a qualified tax professional or CPA regarding your specific circumstances before making any decisions based on this information. This content is provided in accordance with AICPA professional standards and does not create a client relationship with Dental Accounting Group.

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ESSB 5814 Tax Guidance for Dental Study Clubs: What Dentists Need to Know Before October 1, 2025

Washington State’s Engrossed Substitute Senate Bill 5814 introduces significant changes to how professional services are taxed, particularly affecting dental study clubs and continuing education presentations. This article provides our interpretation of the new law and practical guidance for navigating these changes while protecting your interests.

Key Tax Changes Effective October 1, 2025

The new law extends retail sales tax to “live presentations,” defined in RCW 82.04.050(3)(l) as:

“Live presentations including, but not limited to, lectures, seminars, workshops, or courses where participants attend either in-person or via the internet or telecommunications equipment that allows audience members and the presenter or instructor to give, receive, and discuss information with each other in real time”

This creates three distinct scenarios for dental practices:

  1. Study Club Membership Dues: We advise these remain non-taxable (explained below)
  2. Speaking Fees Paid to Presenters: Must include sales tax
  3. Event-Specific Attendance Fees: Subject to sales tax

Our Position: Study Club Dues Are Not Subject to Sales Tax

The Dental Accounting Group takes the position that annual study club membership dues should not be subject to retail sales tax, based on careful analysis of ESSB 5814’s language and structure. Here’s our reasoning:

Legal Basis for the Dues Exemption

The statute specifically targets “live presentations” as discrete, identifiable services. Annual membership dues represent a fundamentally different transaction:

  1. Bundle of Rights Specific Service: Membership dues provide access to multiple benefits including networking opportunities, resource libraries, practice management support, and potential attendance at presentations. They do not constitute payment for any specific “live presentation.”
  2. Timing Distinction: The law contemplates real-time presentations with defined start and end times. Annual dues are paid without reference to specific events, often before any presentations are
  3. Allocation Complexity:
    • Many study clubs allocate dues across multiple purposes: Administrative costs (30-40%)
    •  Venue and hospitality (20-30%)
    •  Materials and resources (15-20%)  Speaker fees (15-30%)

Since only a portion relates to presentations, taxing the entire dues amount would exceed the statute’s scope.

Supporting Arguments

The statute taxes “charges for” live presentations, not general membership fees. Just as country club dues aren’t subject to sales tax despite members using taxable facilities, study club dues represent membership in an organization rather than payment for specific taxable services.

No Department of Revenue guidance contradicts this interpretation. Until specific regulations address membership organizations, reasonable interpretations favoring taxpayers should prevail.

Clear Taxable Transactions: Speaker Fees and Attendance Charges

While we defend the dues exemption, two scenarios clearly trigger sales tax obligations:

1.  Speaking Fees (Paid to Presenters)

Under RCW 82.04.050(3)(l), any dentist or professional receiving compensation for delivering a live presentation must charge sales tax. This includes:

  • Hourly or daily speaking fees  Flat-rate presentation charges
  • Travel stipends tied to speaking engagements
  • Any compensation for real-time educational delivery

Example: Dr. Smith receives $2,000 to present at your study club. She must invoice $2,000 plus applicable sales tax (6.5-10.5% depending on location).

2.  Event-Specific Attendance Fees

When charging non-members to attend specific presentations, sales tax applies:

  • Single-event registration fees
  • Guest attendance charges
  • Workshop-specific fees beyond regular dues

Example: Your study club charges $150 for non-members to attend a hands-on workshop. You must collect sales tax on this amount.

Compliance Strategies for Different Scenarios

For Study Club Operators

Current Approach (Until Further Guidance):

  • Continue collecting annual dues without sales tax
  • Maintain clear documentation showing dues cover multiple benefits
  • Segregate presentation costs in your accounting records

When Hiring Speakers:

  • Require all speakers to include sales tax on their invoices
  • If speakers fail to charge tax, self-report use tax on the untaxed amount
  • Document all speaker agreements specifying tax obligations

For Individual Events:

  • Any charges specifically for attending presentations must include sales tax
  • Create separate fee structures for “membership” versus “event attendance”

For Dentists Who Present

If You Receive Speaking Fees:

  • Register for Washington sales tax collection immediately
  • Add applicable sales tax to all speaking fee invoices
  • Specify on invoices: “Sales tax per RCW 82.04.050(3)(l)”

Calculation Methods:

  1. Add-On Method: Quote $2,000 + sales tax
  1. Inclusive Method: Quote $2,130 with tax included (must “back out” tax: $2,130 ÷ 1.105 = $1,927.60 taxable amount; $202.40 tax due)

Exemptions and Special Circumstances

What Remains Exempt

The following are NOT subject to the new retail sales tax:

  1. Telehealth Services: Patient consultations via video or phone (RCW 04.192(3)(b)(xi))
  2. Educational Institutions: Presentations by accredited colleges/universities to their students
  3. Internal Training: Employee education provided without charge
  4. Pre-Recorded Content: Asynchronous online courses without real-time interaction

Gray Areas Requiring Caution

  • Hybrid Events: Mixing business meetings with educational content
  • Sponsorship Payments: May avoid tax if not tied to specific presentations
  • Material Sales: Books and supplies remain subject to existing sales tax rules

Practical Implementation Timeline

Before October 1, 2025:

  1. Review Current Structure: Document how your study club operates and allocates funds
  2. Update Agreements: Revise speaker contracts to specify tax obligations
  3. Adjust Invoicing: Implement systems to collect tax on taxable transactions
  4. Communicate Changes: Inform members about new requirements

Ongoing Compliance:

  • Track Department of Revenue guidance for updates
  • Maintain clear records distinguishing dues from event fees  Report and remit collected taxes timely
  • Self-assess use tax on untaxed speaker fees

Risk Management Recommendations

Documentation Best Practices

Maintain records showing:

  • Membership benefits beyond presentations
  • Allocation of dues to various purposes
  • Clear separation between dues and event fees
  • Speaker agreements with tax provisions

Audit Defense Preparation

The Department of Revenue will likely scrutinize professional organizations. Prepare by:

  • Establishing written policies before October 1
  • Consistently applying your tax treatment
  • Documenting the business purpose of all transactions
  • Retaining professional tax guidance 

Conclusion and Action Steps

The Dental Accounting Group believes thoughtful structuring can minimize the tax impact of ESSB 5814 on dental study clubs. By distinguishing general membership dues from specific presentation charges, clubs can maintain their current dues structure while ensuring compliance on clearly taxable transactions.

Immediate Actions Required:

  1. Study Club Operators: Document your dues structure and update speaker agreements
  2. Presenters: Register for sales tax collection before accepting October engagements. No action is needed if you have historically accepted speaking fees through your dental practice entity, just make note to report speaking fees on your Sales Tax / B&O filing.

We will monitor Department of Revenue guidance and update our recommendations accordingly. This reasonable interpretation balances compliance with practical business operations while we await specific regulatory clarification.

Please contact our office to discuss your specific situation. As your trusted advisors, we’re committed to helping you navigate these changes efficiently and defensively.

Sincerely,

The Dental Accounting Group

Disclaimer: This article represents our current interpretation of ESSB 5814 based on the statutory language and existing Department of Revenue practices. Tax laws and interpretations may change, and specific situations may warrant different approaches. This article is for educational purposes only. Please reach out to your tax advisor accordingly. 

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If you would be interested in having us speak at one of your upcoming Study Club events, we would be happy to do so. Online meetings are available.  Contact our office for more details: mail@cpa4dds.com

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Running a successful dental practice isn’t just about delivering exceptional patient care — it’s also about making smart financial decisions that protect and grow your business. That’s why choosing the right CPA for dentists can be as important as choosing the right lab or supplier.

For private practice owners, working with a private practice dental CPA offers clear advantages over large, corporate accounting firms. Much like the difference between an independent dental office and a corporate DSO, a private CPA delivers personalized service, aligned incentives, and independent decision-making. We specialize in dental accounting services designed for every stage of your career — from startup tax planning and dental practice growth strategies to retirement transitions — and we do it all with a USA-based dental CPA team that never outsources.

In this article, we’ll compare private vs. corporate CPA models, outline the benefits of partnering with a firm that shares your values, and show why independence matters for both patient care and financial success. Dentists go into private practice for a reason. You want control over your schedule, your patient care, your standards, and the way your business runs. 

The same logic applies to your finances. If you value independence, accountability, and outcomes that truly serve your interests, you need to work with a private practice dental CPA — not a large, corporate accounting machine that has private equity shareholders.  

1. We Care About Clients the Way You Care About Patients

When you run a private dental practice, you know every patient’s name and story. They’re not just a line item on a spreadsheet — they’re people you care about.

That’s exactly how we see our clients.

  • You care about successful treatment outcomes.
  • We care about successful financial outcomes.

And because we’re owners of our firm, our financial incentives are directly tied to your success. When your practice thrives, we thrive. That’s not just a marketing line — it’s our business model.

2. Private vs. Corporate: The DSO Analogy

In dentistry, you know the difference between a private practice and a corporate DSO:

  • In a DSO, decisions are often made far from the operatory by people who have never treated a patient.
  • In private practice, you make decisions with your patients’ best interests at heart.

Large, corporate accounting firms are the DSOs of the financial world. Their size can mean bureaucracy, turnover, and “one-size-fits-all” strategies that don’t fit your unique practice. They have outside investors and management layers whose priorities may not align with yours.

A private practice dental CPA, on the other hand:

  • Makes decisions in-house — no outside investor telling us what to do.
  • Customizes advice based on your goals, not corporate quotas.
  • Builds a long-term relationship with you, not a transactional engagement.

3. Independence Means Better Decision-Making

Because we own our firm outright:

  • We answer only to our clients, not shareholders or a board.
  • We can invest in tools, technology, and continuing education that serve your needs — not corporate cost-cutting measures.
  • We can be nimble — adapting to tax law changes (like the OBBB Act) or shifts in the dental market without waiting for “corporate approval.”

This independence mirrors your freedom as a practice owner to choose your labs, materials, and treatment approaches.

4. We Hire in the USA — Every Day. Never Outsourced.

You’d never outsource crown prep to someone overseas. So why would you let your financial work be sent halfway across the world?

We believe in quality at every step — which means:

  • Every team member is US-based.
  • Every report, forecast, and tax plan is created and reviewed by professionals who understand your business and your regulatory environment.
  • We protect your data and your trust by keeping your information in-house.

5. Quality of Care — From Graduation to Retirement

Your relationship with a private practice dental CPA isn’t just about “doing your taxes.”
It’s about having a financial partner through every stage of your career:

  • Startup: Entity choice, financing strategy, budget planning.
  • Growth: Overhead control, KPI benchmarking, tax optimization.
  • Maturity: Retirement planning, wealth transfer, practice sale strategy.

At each stage, the focus is on outcomes that align with your definition of success — not someone else’s quarterly targets.

6. The Result: Long-Term, Aligned Success

Corporate firms often work in volume. They can afford to lose a client because they’re chasing the next big account.

We can’t — and don’t want to — work that way.
Like you, we want a healthy, sustainable practice, built on trust and quality. That’s why we put in the work to understand your numbers, your vision, and your challenges.

Bottom Line

Private practice dentists choose independence because it delivers better patient care and better outcomes.
The same is true for your financial care. Working with a private practice dental CPA means:

  • Aligned incentives.
  • No outside control.
  • Uncompromising quality.
  • A partner for the life of your career.

Because when you win, we win. And that’s exactly how it should be. 

Questions? – Feel free to reach out to Kevin@dentalaccountingpros.com or Kevin@cpa4dds.com 

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STUDY CLUBS

If you would be interested in having us speak at one of your upcoming Study Club events, we would be happy to do so. Online meetings are available.  Contact our office for more details: mail@cpa4dds.com

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Press Release

FOR IMMEDIATE RELEASE

Dental Accounting Group Named to Inc. 5000 List for Second Consecutive Year — Leading the Way in Specialized Dental Practice Accounting

Bellevue, WA — August 13, 2025 — Dental Accounting Group, a leading provider of specialized accounting, tax, and advisory services for dental practices, has once again been recognized on Inc. Magazine’s prestigious 2025 Inc. 5000 list of America’s Fastest-Growing Private Companies. This marks the second consecutive year the firm has earned this distinction, underscoring its position as the trusted choice for dentists nationwide seeking financial clarity, compliance, and strategic growth.

The Inc. 5000 list ranks companies based on percentage revenue growth from 2021 to 2024, spotlighting businesses that are driving innovation and resilience in their industries. Dental Accounting Group’s back-to-back recognition highlights not only consistent growth, but also its ability to deliver unmatched value in a highly specialized market.

“Making the Inc. 5000 list for the second year in a row is a direct reflection of our mission — to give dental professionals the financial confidence they need to grow,” said Kevin Bray, Partner & Client Advisor at Dental Accounting Group. “We’re unique in that we only hire full-time W-2 employees based in the United States. We never outsource overseas. Our clients know exactly who’s handling their financial data, and they can trust it’s secure, accurate, and managed by experts who understand the dental industry inside and out.”

Unlike general accounting firms, Dental Accounting Group focuses exclusively on the dental industry. Its services are designed to address the unique operational, regulatory, and financial needs of dental practices. From bookkeeping and tax planning to CFO-level consulting, payroll, bill pay, and cash flow forecasting, the firm’s subscription-style service packages scale with each practice’s growth.

“Our niche focus allows us to see trends and opportunities that others miss,” added Bray. “We pair this deep industry knowledge with an industry-leading technology stack that ensures both security and efficiency. Our clients aren’t just getting accounting — they’re getting a strategic partner invested in their success.”

Why Dental Accounting Group Leads the Industry:

  • 100% USA-Based Team — Every team member is a full-time W-2 employee located in the U.S.

  • Never Outsourced — Sensitive financial data never leaves the country.

  • Industry Expertise — Serving dental professionals exclusively for unmatched insight and guidance.

  • Cutting-Edge Technology — Secure platforms for efficiency and protection.

  • Scalable Service Plans — Flexible options to match any stage of practice growth.

Dental Accounting Group works with practices of all sizes — from solo dentists to multi-location groups — delivering the financial clarity, compliance, and proactive tax strategies that drive profitability and long-term success.

For more information on Dental Accounting Group’s services and to book an initial consultation, visit dentalaccountingpros.com/contact/.

Complete results of the 2024 Inc. 5000, including company profiles and rankings, can be found at Dental Accounting Group’s Inc. 5000 Profile.

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The OBBB (Oh-Triple-Bee as we are starting to call it) Act officially passed and signed into law on July 4th, 2025 by the President. We have been diligently reviewing source material to craft our tax planning approach for 2025 and future years. Please note that we are still waiting for additional IRS guidance, but in the interim, here is a short summary of the key tax provisions:

Key Takeaways for Dentists:

  • Tax rates from the 2017 Tax Cuts & Jobs Act made permanent
    • 10%, 12%, 22%, 24%, 32%, 35%, and 37%
    • Enhanced inflation adjustment for 10%/12%/22% brackets.
  • Qualified Business Income Deduction made permanent at 20%
  • State and Local Tax (SALT) limit raised to $40k ($20K MFS) with a phase-down over $500k of Modified Adjusted Gross Income. Reverts back to $10k in 2030.
  • SALT cap increases 1% per year starting in 2025 through 2029

The Pass-Through Entity (PTE) tax work around was on the chopping block, but in the final Senate version this tax saving strategy for business owners was saved, which will benefit high-earning practice owners in income tax states like California and Montana.

  • Child tax credit increased to $2,200 per child, adjusted for inflation thereafter. Phase out begins at $400k Modified Adjusted Gross Income (if filing jointly).
  • Trump Retirement & Savings Account (Trump Account) is introduced – Invest up to $5,000 per child per year until the child turns 18. Funds must be invested in US stock market index funds. The US Government will give $1,000 per baby born between 2025 – 2028.
    • Employers can make up to $2,500 in nontaxable contributions per employee. We need more guidance from the IRS regarding compliance.
    • Trump accounts grow tax-deferred until the beneficiary withdraws the money.
  • Expanding the use of section 529 tax-advantaged savings accounts for qualified higher education expenses, including “qualified postsecondary credentialing expenses” related to professional licensure. We believe CE programs like AGD, Spears and KOIS fall under this new definition. 
  • Charitable deductions: Under OBBBA, the deduction has been expanded to include a permanent “above-the-line” deduction for taxpayers who do not itemize their deductions. Beginning in 2026, taxpayers who do not itemize can claim a deduction of up to $1,000 ($2,000 for those taxpayers who are married filing jointly) for certain charitable contributions. Taxpayers who itemize are subject to a 0.5% floor of their modified adjusted gross income. For example, a household with $300k in MAGI would not be able to deduct the first $1,500 in charitable contributions. New carryover rules would also apply. OBBBA also makes the 60% contribution limit for cash gifts to qualified charities permanent.
  • Green energy tax credits are repealed including electric vehicle credits, installation of home EV charging equipment, and some residential energy credits such as insulation, windows, or energy efficient heating and cooling systems (including solar). Most Inflation Reduction Act (IRA) credits will terminate 2025-2027. 
  • Exemption for overtime pay up to $12,500 per year (2025 to 2028) via a tax deduction (above the line). Must be reported on Form W-2 (waiting on additional guidance).
  • Above the line deduction for auto loan interest up to $10,000 per year (2025 – 2028). The car must be new (not used) and be assembled in the United States.  EV cars are eligible. Debt must have been incurred after 12/31/24. Deduction is completely phased out when income is over $150k ($250k married filing jointly)
  • Senior Citizens aged 65 and older will get an additional $6,000 added to their standard deduction (in an effort to offer relief to those collecting Social Security (2025 – 2028).
  • Health Savings Account (HSA) changes – expanded coverage & eligibility.
  • Employer education plans paying student loan payments – extended permanently.
  • Increasing the filing threshold for Forms 1099-NEC and Forms 1099-MISC from $600 to $2,000, adjusted for inflation.
  • The 100% depreciation deduction is now permanent. This replaces the phase-down of 40% for property after January 19, 2025.
    • A temporary 100% expensing for qualifying structures that start construction in 2025-2028 will be granted.
  • The OBBB Act overhauls federal student loan repayment by eliminating all existing Income-Driven Repayment (IDR) plans and replacing them with the standard repayment plan and the Repayment Assistance Plan (RAP). While RAP caps monthly payments at 10% of discretionary income, it extends the repayment period to 30 years (360 payments) before any remaining balance is forgiven, compared to current plans that offer forgiveness after 10-25 years.
  • The temporary increase to the estate and gift tax exemption has been made permanent and increased further to $15 million.
  • Higher exemptions and phase-out thresholds for the Alternative Minimum Tax have been made permanent, meaning very few taxpayers will be subject to it.
  • Total itemized deductions are subject to a new phase-out for higher incomes. The otherwise allowable deduction is reduced by 2/37 of the lesser of (1) the amount of the itemized deductions or (2) the amount of the taxpayer’s taxable income that exceeds the start of the 37% tax rate bracket.

Impact for Dental Practice Owners:

Most of our clients will continue to benefit from key tax provisions passed in the original Tax Cuts and Jobs Act (TCJA) from 2017. We continue to review text from the One Big Beautiful Bill Act and participate in CPA industry group discussions. We will keep you updated as information becomes available from the IRS.

Any Questions? Feel free to reach out to our office.

-Your Dental Accounting Group

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STUDY CLUBS

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2025 brings some notable changes to local taxes in Washington State. 

Capital Gains Tax 

The Washington capital gains tax has been in place for a few years now.  Washington taxpayers are subject to a 7% tax on long-term capital gains that exceed an annual threshold (currently $270,000).  An additional 2.9% tax is now being added for taxable gains above $1 million.  This retroactively applies to any gains realized as of January 1, 2025. 

With the annual exemption, this essentially means you must have long-term capital gains of $1,270,000 before the additional tax applies.  The first $270,000 is still exempt, and gains from $270,000 – $1,270,000 are still taxed at 7%.  Only the gains exceeding this amount are taxed at 9.9%. 

There are no changes to the existing exemptions and deductions, such as gains on real estate, retirement accounts, and qualified family-owned small businesses. 

Estate Tax 

Many are aware of the increased federal estate tax exemption.  When someone dies, they can leave assets to their heirs without paying any estate tax as long as the estate is under $13.99 million (or $27.98 for a married couple).  This effectively means that very few people need to worry about the federal estate tax.  (Note that this is currently scheduled to sharply decrease next year, although legislation is currently in the works that could extend it). 

However, many states also have a state estate tax, including Washington.  The state exemption is currently much lower, at $2.193 million and has been unchanged for several years.  It will increase to $3 million on July 1, 2025, and it will be indexed to inflation each subsequent year.  Note that unlike the federal exemption, this is not “portable” between spouses, meaning you cannot double the exemption to get $6 million per couple.  When the first spouse dies, everything can pass to the surviving spouse tax free.  But when the second spouse dies, they will only be entitled to a $3 million exemption, the same as someone who was never married. 

While the increased exemption will allow more people in the state to avoid the state estate tax, once you are above that exemption, the rate at which you pay the estate tax is increasing.  Similar to the federal income tax, the state uses progressive brackets where larger estates pay a larger percentage in taxes.  The rates currently range from 10%-20%, but the top bracket will now increase to 35%. 

Taxable Estate (amount above exemption) 

Current Rates 

Rate as of 7/1/25 

<$1m 

10% 

10% 

$1m – $2m 

14% 

15% 

$2m – $3m 

15% 

17% 

$3m – $4m 

16% 

19% 

$4m – $6m 

18% 

23% 

$6m – $7m 

19% 

26% 

$7m – $9m 

19.5% 

30% 

>$9m 

20% 

35% 

Business owners can also take advantage of another exclusion, if the value of the business owned makes up over 50% of the taxable estate and has been actively operated by the decedent or a family member for at least five of the previous eight years.  Currently, you can exclude $2.5 million of the business from your total estate value.  That amount is increasing to $3 million. 

However, if the business is later sold, or the business no longer qualifies within three years of death, the State can go back and assess tax on the business as if it had been included in the taxable estate. 

Should you have any questions on these tax changes, or how you can best plan to limit your exposure, please do not hesitate to reach out to us. 

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STUDY CLUBS

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The PDF version of our formal letter can be found Here

January 29, 2025

RE:        Testimony in support of HB 1535 / SB 5351

Our firm specializes in working with dental practices, which we have been doing since 1989.  We understand the economics of the dental profession, how the current financial model dictated by large insurance carriers is threatening its financial health, and how this directly leads to less access to care and more expense for patients.

Here’s some background on the economics of a dental practice.  Dental graduates typically leave school saddled with $300,000 or more in student debt.  In addition to servicing that debt, they will require nearly $1 million in financing if they want to buy or open a basic clinic.  Once a clinic is up and operating, it faces economic challenges over which it has little control.  Post-pandemic, we have seen a decline in experienced dental office employees, a trend identified by the American Dental Association as a critical challenge for the dental profession nationwide.  Due to this acute shortage of experienced dental workers (especially hygienists), average dental employee wage rates have increased by at least 30% in the last five years alone across Washington (and up 40% in Seattle/Bellevue Metro).  Other expenses have also increased, if not as significantly.

Despite these rising costs and despite an overall increase in the general Consumer Price Index of more than 45% since 2010, dental benefit reimbursement rates have remained relatively flat.  Delta Dental of Washington (DDWA), by far the largest carrier in the state, unilaterally reduced its reimbursement rates by approximately 15 percent in 2011 and froze those rates for 10 years. More recently, DDWA has increased reimbursements by approximately 3% in 2024 and 4% for 2025 for select Current Dental Terminology (CDT) reimbursement codes.

These increases are insufficient to keep up with rising costs, much less make a dent in the gap created by more than a decade of frozen reimbursements.  They create a clear imbalance between the huge costs associated with obtaining a dental education and operating a dental clinic and the potential rewards for pursuing a career in dentistry.  In short, the current financial model is killing the future of the profession. It is a formula for a shrinking number of providers and a decline in the supply of dental care resources – reducing access, availability and quality of care. In the end, patients are the ones that will suffer.

We have seen this trend in the medical profession over the last 20 years, where changing economics have led to provider consolidation, private equity acquisition of health systems, and diminished access to care for patients. 

HB 1535 and SB 5351 can help prevent this from happening in the dental arena.  It will:

  • Support dentists in covering rising expenses like wages, equipment, and rent
  • Ensure parity of reimbursement between in-network and out-of-network providers, giving patients true freedom to choose their dentist and unrestricted access to the benefits they are paying for. 
  • Reduce anti-competitive practices by dominant insurers (For example, several insurers already provide relative parity for in-network and out-of-network reimbursements, but DDWA as the dominant player does not.).
  • Provide sufficient economic incentives for students to pursue dentistry, critical for maintaining an adequate dental workforce and appropriate access to care
  • Prevent rural and underserved communities from losing access to dental care
  • Mandate insurance plans spend 85% of premium revenue on care, not profits or administrative costs.

Everyone in Washington will benefit from a more competitive and better functioning market for dental benefits.  It will allow dentists to tailor their practices to compete for and meet the needs of their patients without insurance companies dictating how and how much they are reimbursed for the care they provide.  It will allow patients to pick the dentist they are most comfortable with and not be forced to accept a lower level of benefits because of that choice.  It will allow insurance companies to adjust their reimbursement rates to become more competitive.  Premera’s recently announced plan to increase its reimbursement rates 24% clearly shows how this can benefit consumers.  Most importantly, it will require that 85% of patients’ premium dollars are directed to their care, helping ensure that they – and the dental profession that cares for them – remain healthy in the years ahead.

We urge you to support this vitally important legislation.

ADDITIONAL BACKGROUND INFORMATION

  • Dental care is financed in large part by employer provided dental insurance.

  • Delta Dental of Washington (DDWA) covers the majority of insureds in Washington State. In some markets, it exceeds 80% of the patient population. Premera and Regence also have large insured populations. We refer to these as The Big 3.

  • Effective July 2011, DDWA reduced their reimbursement rates to providers by roughly 15% with some more frequently used CDT codes, such as those for preventive care, being cut even greater than 15%. DDWA froze those lower rates for 10 years

  • In 2024, DDWA increased a handful (around 20 of the over 800 CDT codes) of the CDT reimbursement rates by approximately 3%. For 2025, DDWA has increased some CDT reimbursement rates by approximately 4%, with an emphasis on selective hygiene CDT codes.  

  • Premera followed DDWA’s lead in 2018 with a significant cut to their CDT reimbursement rates. Premera and Regence have followed DDWA’s frozen reimbursement rate model in lockstep. Premera is one carrier that pays the same in-network reimbursement rate to out of network providers which allows insureds unrestricted provider choice and full access to their benefits.

  • Following Premera’s rate cut in 2018, based on experience with our clients, a substantial number of clinics dropped out of Premera’s PPO network. The out of network reimbursement rates for many carriers, with the exception of DDWA, are on par or nearly on par with in-network reimbursement rates without transferring an onerous financial burden to patients who choose to continue their relationship with their dental provider regardless of their PPO status. Delta, on the other hand, slashes reimbursement rates as low as 20% of in network rates, even for preventive care, and transfers the financial burden of dental care back to those patients who choose/desire to continue with their established dental provider. DDWA’s punitive financial terms for out of network providers (and patients that desire to continue working with their long-term provider that has dropped their DDWA PPO status) are so onerous that it forces most patients to transfer to an in-network provider. Dictating consumers (patients) to seek services solely from in-network providers due to DDWA’s control and influence in the market is anti-competitive and monopolistic, especially when you factor in the punitive outcome to both providers and patients that are out of network. It is a barrier to a patient’s choice and access to care.   

  • Market conditions (presumably Premera insureds complaining about difficulties to access care with in-network providers) must have come into play to trigger Premera to raise their reimbursement rates by 12% effective October 1, 2024 and another 12% effective March 1, 2025. Given the frozen reimbursement rate environment since 2011, Premera’s 24% rate increase within 5 months is a “drastic” reaction to presumably free market forces.

THE CURRENT PPO BASED FINANCIAL MODEL IS NOT SUSTAINABLE

  • The Big 3 carriers have monopolistic influence in the marketplace. They dictate what providers can charge for their services. They have influence over approving or disapproving insureds claims diagnosed by their providers. Because they “control” the majority of “customers,” they make it nearly impossible to compete for doctors who choose to drop out of the carrier’s PPO networks.

  • Between 2010 and 2024, the consumer price index (CPI) has increased by 45.65%. The CPI is a measure of increasing costs. Meaning how much the cost of delivering dental services has increased over the 10 plus years that reimbursement rates have been frozen. Post the 2020 pandemic, we have seen a decline in experienced dental office employees which has been identified by the ADA as a nationwide critical challenge for the industry. Combine the short supply of experienced dental workers with wage inflation in recent years, dental employee wage rates have increased by 30% just in the last five years alone across Washington on average (and up 40% in Seattle/Bellevue Metro).

  • The medium-term trajectory for this model threatens the economic viability of independent private practice and leads to a declining interest in the profession due to the miss-match with the financial reward relative to the huge investment (educational costs and student loans). The University of Washington’s current projected cost for an in-State student to complete dental school is approximately $432,000. We regularly see new dental grads saddled with student debt in excess of $300K at current interest rates in the 7% to 9% range. Currently it typically cost a dentist at least $1.0M in practice financing to buy or open a basic clinic. The long-term implications we are potentially faced with is a shrinking number of providers relative to a growing population which will stress insureds access to in-network dental care. The current financial model is killing the future of the profession. It is a formula for a decline in the supply of dental care resources – reducing access, availability and quality of care. In the end, patients are the ones that will suffer. Simply look at what has been going on with medical care over the last 20 years as a predictor of future dental care without needed structural changes with the financial model. Medicine has pivoted to a concierge model which is simply a pay for access model which has created financial barriers to accessing highly experienced and sought after providers. The concierge model, created out of the financial failings of the PPO model, allows providers to deliver quality care that is focussed on the patient’s needs and not dictated by a carrier’s claim approval or subsistence reimbursement rates. One could argue that the concierge model has created a two-tier health care system. One able to deliver unbridled high-quality care to those with financial resources and a second constrained by the financial model dictated by the carriers for everyone else. This can be avoided in dentistry with some needed structural changes in the financial arrangement between the carriers, the providers and patients.  

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COMPANY BIO

DG Accounting Professionals LLC dba Dental Accounting Group 

  • Washington Chapter of the Academy of Dental CPAs
  • We are a dental specific CPA firm that works with hundreds of dental practices.
  • We are a member of an exclusive organization of dental CPA firms (the Academy of Dental CPAs) nationally that serve over 11,000 practice units.
  • We understand the economics of the dental industry and the in-network or PPO financial model dictated by the large dental insurance carriers.

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LEADERSHIP BIOS

Brian F. Bray, CPA
Co-Managing Partner | Senior Client Advisor
Working with dentists since 1989

Brian has been a Certified Public Accountant and business advisor for over 40 years and is Co-Managing Partner of the Dental Accounting Group. Brian offers clients a business-minded perspective, sharpened by decades of practical experience, to help clients grow and improve their business. He is passionate about helping the next generation of dentists learn how to be financially successful in today’s challenging economic environment.

Affiliations:
Washington Society of Certified Public Accountants
American Institute of Certified Public Accountants
Academy of Dental Certified Public Accountants

Education:
University of Washington

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Margaret M. Boyle, CPA
Co-Managing Partner | Senior Client Advisor
Working with dentists since 1990

Maggie is the Co-Managing Partner of the Dental Accounting Group. She is a University of Washington graduate, a Certified Public Accountant (CPA) and a former Certified Valuation Analyst (CVA). Maggie has been providing tax, consulting and planning services to dental professionals since 1990. She served on the board of the ADCPA for 6 years and is the Washington representative for the Academy of Dental CPAs, a select group of 26 CPA firms throughout the US that provide progressive consulting, accounting and tax services to dental professionals. Maggie has guest lectured at the University of Washington Dental School, SKCDS and many local study clubs.

Affiliations:
Washington Society of Certified Public Accountants
Academy of Dental Certified Public Accountants

Education:
University of Washington

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Kevin J. Bray
Partner | Client Advisor
Working with dentists since 2014

Kevin has been working with Dentists since 2014, building a dental focused bookkeeping practice from scratch, that later merged with the Dental Group to form the Dental Accounting Group in 2022. DAG was recently honored as one of the Puget Sound Business Journal’s Best Places to Work in 2024 and was featured in the INC. 5000’s Fastest Growing Companies in America list. Kevin is passionate about building businesses, financial planning and education.

Affiliations:
Academy of Dental Certified Public Accountants

Education:
University of Washington
Washington Governors University

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Questions?  Please email us at mail@cpa4dds.com or call us at 425.216.1612

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Bellevue, WA  9804

 

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If you would be interested in having us speak at one of your upcoming Study Club events, we would be happy to do so. Online meetings are available.  Contact our office for more details: mail@cpa4dds.com

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Another Important Update… as this issue appears to continue unfold. There is another temporary pause on enforcement. Regardless, our recommendation is to discuss with your attorney and pre-emptively file assuming it moves forward. It’s not worth the time and energy thinking about it. File and move on… Not legal or tax advice. Just sharing my opinion as a business owner and what I would do. 

Best,
–Kevin 

 

Important Update: On December 23rd, 2024 a ruling out of the Fifth Circuit’s Court has reinstated the BOI Reporting requirements. 

In response to the Court decision of Dec. 23, the Financial Crimes Enforcement Network (FinCEN) has announced the following updated deadlines for beneficial ownership information (BOI) reporting:

Extended Deadlines for Existing Companies

Companies created or registered before Jan. 1, 2024, must file their initial BOI reports by Jan.13, 2025 (extended from Jan. 1, 2025).

Extensions for Recently Registered Companies

Companies registered between Sept. 4, 2024, and Dec. 23, 2024, now have until Jan. 13, 2025, to file their BOI reports.
Companies registered between Dec. 3, 2024, and Dec. 23, 2024, receive an additional 21 days from their original filing deadline.

Disaster Relief Extensions

Depending on their circumstances, companies qualifying for disaster relief may have filing deadlines beyond Jan. 13, 2025.

New Companies Starting in 2025

Companies registered on or after Jan. 1, 2025, must file their BOI reports within 30 days of their creation or registration becoming effective.
Additionally, plaintiffs in the case National Small Business United v. Yellen are not currently required to report their BOI to FinCEN.

This update follows the Fifth Circuit’s stay of a nationwide preliminary injunction against the Corporate Transparency Act (CTA), pending the Department of the Treasury’s appeal.

Written by Kevin J. Bray, Partner @ the Dental Accounting Group

As a dental practice owner, staying compliant with the ever-evolving regulations is essential to maintaining your business’s integrity and avoiding unnecessary penalties. A critical new requirement for businesses, including dental practices, is the Beneficial Ownership Information (BOI) filing mandate. This regulation is aimed at enhancing transparency in business operations and ensuring compliance with legal standards. In theory the new law has good intentions, but in practice it’s creating confusion and another layer of compliance headache for small business owners. Here’s everything you need to know about BOI filings and how to stay ahead of the curve.

What Is BOI Reporting?

The BOI filing requirement mandates businesses to disclose information about individuals who own or control a significant portion of the company. This initiative is part of broader efforts to prevent financial crimes such as fraud and money laundering by ensuring that ownership structures are transparent. Business Ownership Information (BOI) reports with the U.S. Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN). This new filing is a result of The Corporate Transparency Act (CTA) that went into effect on January 1, 2024, requiring businesses to now file ownership information with FinCEN to help identify criminal activity.

Key Facts You Should Know

Here are the main highlights of the BOI filing requirements:

  • Who Needs to File: If you registered your business with the Secretary of State in your state, you are required to file. All limited liability companies (LLCs) and corporations must file. Disregarded entities, for U.S. tax purposes, must also file. For example, if you own multiple LLCs, each requires a separate BOI report. This includes all dental practices and other businesses as well as Single Member LLCs holding real estate.
  • How to File: You will need to file directly with FinCEN on their website https://boiefiling.fincen.gov/or engage legal counsel to file on your behalf.
  • Filing Deadline: If your business existed as of January 1, 2024, you must file your BOI report by January 1, 2025.
  • Penalties for Non-Compliance: Failure to file on time can result in significant penalties, including fines of $591 per day, a potential $10,000 criminal penalty, and up to two years in prison.

Next Steps for Dental Practice Owners

If you haven’t yet filed your BOI report, now is the time to act. Here’s what you should do:

  • Contact Your Attorney: Reach out to your attorney to understand the specific filing requirements for your practice. They can guide you through the process and ensure compliance.
  • Gather Required Documentation: Collect all necessary details about the beneficial owners of your business. This includes full names, ownership percentages, and any supporting documents.
    1. Company legal name and current address
    2. Any assumed business name (DBA) used by the company
    3. EIN of the entity (Federal tax ID)
    4. Ownership information – Each owner’s name, birthdate, residential street address, and social security number
    5. A high-resolution PDF copy of your driver’s license or passport
  • Submit Your Filing: Work with your attorney to file the report accurately and on time. There are multiple providers in the space offering to assist with this, but we recommend proceeding with caution due to the sensitive nature of the information. DO NOT SHARE YOUR SENSITIVE PERSONAL & FINANCIAL INFORMATION WITH UNKNOWN SERVICE PROVIDERS. 

Key Deadlines: 

  • Existing businesses formed before January 1, 2024 – file by January 1, 2025
  • New businesses formed on or after January 1, 2024 – file within 90 days of business formation
  • New businesses formed on or after January 1, 2025 – file within 30 days of formation

The Bottom Line

Compliance with the BOI filing is a small task, but has huge penalties. We recommend all business owners (and real estate LLC’s) take prompt action. Don’t hesitate to contact your attorney to ensure your BOI filings are handled correctly and to avoid any penalties.

Stay informed, stay compliant, and focus on what you do best—caring for your patients!

Disclaimer: DG Accounting Professionals LLC dba Dental Accounting Group is not filing BOI for clients. This is a legal matter and we are not licensed to practice law. Work with your attorney to file the report accurately and on time. 

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Questions?  Please email us at mail@cpa4dds.com or call us at 425.216.1612

3015 112th Ave NE, Suite 210

Bellevue, WA  9804

 

STUDY CLUBS

If you would be interested in having us speak at one of your upcoming Study Club events, we would be happy to do so. Online meetings are available.  Contact our office for more details: mail@cpa4dds.com

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Written by Kevin J. Bray, Partner @ the Dental Accounting Group

Navigating the financial landscape of a dental practice is a bit like perfecting a smile makeover – it requires precision, expertise, and a keen eye for detail. As dental CPAs specializing in accounting and business advisory for more than 400 dental practices in the Pacific Northwest, we’ve seen firsthand how crucial it is to keep a finger on the pulse of your practice’s financials. Much like advising patients on the importance of regular dental check-ups, we recommend that owners review their financials monthly as a preventative measure against fiscal decay and a strategy for cultivating a thriving practice.

What is Financial Benchmarking?

Financial benchmarking, in the context of a dental practice, involves the analysis and comparison of your practice’s financial performance against that of similar practices within your geographical area. Using local data vs national averages is important when creating budgets and production goals. For example, insurance reimbursements and staffing costs for a practice in Washington are going to vary significantly from a practice in Iowa. By comparing your financial health to that of like-kind practices, you will gain valuable insights into local market dynamics, competitive positioning, and potential areas for improvement or growth. This laser-focused approach enables you to make informed decisions, set realistic goals, and implement best practices, ultimately scaling your practice to new heights of success.

Key Overhead Benchmarks at a Glance:

  • Staff Expenses: 36.48%
  • Dental Supplies: 6.89%
  • Lab Fees: 5.01%
  • Facility Expenses: 6.85%
  • Marketing Expenses: 1.13%
  • Merchant Service Fees: 3.32%

Note: These benchmark figures are based on 2023 financial survey data for general practices between $800k to $1m in annual revenue. This is only a snapshot from our extensive Practice Analysis Report.

Additional Key Performance Indicators That Every Practice Should Track:

  • New Patient In-flow
  • Average Daily Production
  • Hourly Chairside Production
  • Gross Production, Net Production & Net Collections
  • Accounts Receivable Aging
  • Profit Margin Before Owner & Associate Compensation

Fiscal Hygiene: Clean Up Your Practice’s Accounting Records

At the heart of effectively managing these benchmarks lies the imperative approach of keeping clean bookkeeping records and a streamlined dental specific chart of accounts. This is equivalent to maintaining a well-organized dental office where every instrument has its place, simplifying diagnosis and treatment. Clean financial records ensure that every transaction is accurately captured, enabling a clear view of the practice’s fiscal state. At the Dental Accounting Group, we use a standardized dental practice chart of accounts across all of our clients, which allows us to synchronize data into customized benchmarking reports.

Create the Habit of Reviewing Your Financials Monthly

Don’t wait until the end of the year to complete your bookkeeping. If you don’t have the time, then hire a professional bookkeeper. Think of bookkeeping and reviewing your financials as your patient’s routine cleaning: it’s essential for identifying small issues before they require major restorations. Just as regular dental cleanings and exams are essential for maintaining oral health, a disciplined approach to bookkeeping and tracking your financials with benchmarks is crucial for the vitality of your dental practice. Embrace the routine financial check-ups with the same enthusiasm you have for patient care and watch your practice not just grow, but flourish!

Need better bookkeeping and financial reporting?
Reach out to us today

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Questions?  Please email us at mail@cpa4dds.com or call us at 425.216.1612

3015 112th Ave NE, Suite 210

Bellevue, WA  9804

 

STUDY CLUBS

If you would be interested in having us speak at one of your upcoming Study Club events, we would be happy to do so. Online meetings are available.  Contact our office for more details: mail@cpa4dds.com

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The following alert comes from the American Dental Association.

 

On Tuesday, May 6, 2024, the FBI informed the ADA and the American Association of Oral and Maxillofacial Surgeons (AAOMS) of a credible cybersecurity threat to the practices of oral and maxillofacial surgeons. The FBI said that as of that date, there were no known cyberattack victims, but the agency is working proactively to raise awareness to help prevent victimization. The FBI suspects the group behind the cyberattacks may be shifting tactics to oral and maxillofacial surgery practices after targeting plastic surgeons last year.

While this current threat is focused on oral and maxillofacial surgeons, the FBI is concerned that the practices of general dentists and other specialists could also eventually be targeted.

Cybercriminals often use social engineering scams — such as phishing (email), SMSishing (through text or instant messaging apps) and vishing (using phone calls and voicemail) — to gain access to sensitive personal data such as electronic protected health information. Spear phishing refers to a phishing email appearing to be from a trusted contact. For example, a threat actor may use phishing to impersonate a credentialing agency. Through these scams, threat actors try to convince people to reveal sensitive information, or to click on a link, open an attachment or visit a website that causes malware to be deployed. This malware can lead to ransomware, which blocks system and/or file access  until money is paid.

The FBI provided an example in which the threat actor poses as a new patient or says they want to become a patient at the practice to obtain new patient forms online. Once the forms are received, the threat actor will then contact the practice to report they are having trouble submitting them online and ask if they can scan the forms and email them instead. The threat actor then emails the “forms” as an attachment. When the attachment is opened, malware is deployed in a phishing scheme.

The FBI requests dental practices that experience any fraudulent or suspicious activities to report them to the FBI Internet Crime Complaint Center at ic3.gov.

Precautions Practices Can Take
The Cybersecurity & Infrastructure Security Agency (CISA) recommends four vital ways to protect your practice from cyberthreats:

The following resources are also available to support healthcare professionals:

  • A CISA.gov toolkit aids healthcare practices in building cybersecurity foundations and implementing more advanced, complex tools to stay secure and ahead of current threats.
  • The U.S. Department of Health and Human Services’ Knowledge on Demand resource offers five free cybersecurity trainings that align with the top five threats named in HHS’ Health Industry Cybersecurity Practices. HHS also offers information on how the HIPAA security rule can help defend against cyberattacks.
  • The Office of the National Coordinator for Health Information Technology’s Security Risk Assessment Tool, a resource designed to help medium and small providers conduct a security risk assessment as required by the Health Insurance Portability and Accountability Act.
  • The U.S. Department of Health and Human Services Office of Information Security and Health Sector Cybersecurity Coordination Center’s “Artificial Intelligence, Cybersecurity and the Health Sector” guide shares how health care entities help protect against AI-enhanced cyberthreats.
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Questions?  Please email us at mail@cpa4dds.com or call us at 425.216.1612

3015 112th Ave NE, Suite 210

Bellevue, WA  9804

 

STUDY CLUBS

If you would be interested in having us speak at one of your upcoming Study Club events, we would be happy to do so. Online meetings are available.  Contact our office for more details: mail@cpa4dds.com