Understanding your sales and use tax obligations in Washington State is essential for maintaining compliance and avoiding costly penalties. Whether you operate a dental practice, professional services firm, or retail business, staying current with these requirements can save you significant time and money.

This guide breaks down everything you need to know about Washington’s sales and use tax system, including recent legislative changes that took effect in late 2025.

Understanding Sales and Use Tax in Washington

What Is Sales Tax?

Sales tax is imposed on retail sales of most goods and certain services in Washington State. When your business sells taxable items or services to customers, you must collect the applicable sales tax at the point of sale and remit it to the Washington Department of Revenue (DOR).

The combined state and local sales tax rates vary by location, ranging from 6.5% (the state base rate) to over 10.5% in some areas, such as parts of King County. It’s important to apply the correct rate based on where the sale occurs.

What Is Use Tax?

Use tax serves as the counterpart to sales tax. It applies when your business purchases taxable goods or services from out-of-state vendors (or in-state vendors who fail to charge sales tax) and uses those items in Washington.

The use tax rate equals the sales tax rate that would have applied if the purchase had been made locally. Business owners are responsible for self-reporting and remitting use tax on their Combined Excise Tax Return.

Who Is Subject to Sales and Use Tax?

Washington businesses are generally subject to sales and use tax obligations if they meet any of the following criteria:

       Have a physical presence in Washington (office, employees, inventory, or business location)

       Meet the economic nexus threshold of $100,000 or more in gross receipts sourced to Washington in the current or prior year

       Sell taxable goods or services to Washington customers

       Purchase items or services for use in Washington without paying sales tax

Special Considerations for Dental Practices and Service Businesses

While professional dental services are generally not subject to sales tax, practices must still collect sales tax on certain retail items sold to patients, such as oral care products sold over the counter. Additionally, dental practices must pay use tax on business purchases where applicable, including acquired assets when buying a practice.

Service businesses like dental practices are also subject to a state (and sometimes city) Business and Occupation (B&O) tax on gross receipts. This typically ranges from 1.5% to 2%, depending on the location of the business and whether there is an applicable city tax rate.

Recent Changes: ESSB 5814 and New Sales Tax Categories

Effective October 1, 2025, Washington’s ESSB 5814 extended retail sales tax to several new categories that may significantly impact your business operations.

Advertising Services Now Subject to Sales Tax

The new law broadly defines taxable advertising services as “all digital and nondigital services related to the creation, preparation, production, or dissemination of advertisements.” This encompasses a wide range of activities, including:

       Website development and design

       Logo design and branding

       Search engine optimization (SEO) services

       Acquisition of advertising space

       Consulting and advice on advertising methods

Live Presentations and Speaking Engagements

Seminars, workshops, and continuing education events where participants attend in-person or via real-time telecommunication are now subject to sales tax. This has important implications for professionals who receive compensation for speaking engagements—they must now collect and remit sales tax to the Department of Revenue.

What Remains Exempt

Several advertising-related categories remain exempt from sales tax:

       Radio and television advertisements

       Newspapers

       Fixed signage such as billboards

       In-store displays

Outside of these specific exceptions, the State generally assumes that anything related to advertising is subject to sales tax.

What to Look For: Ensuring Compliance

While vendors are responsible for collecting sales tax, many may not yet be aware of the new rules—particularly if you work with out-of-state vendors. Here’s what you should do:

1.    Review your advertising invoices to verify whether sales tax is being charged.

2.    Contact vendors who aren’t charging sales tax to understand their reasoning. They may have a valid exemption (such as minimal presence in Washington) or may have inadvertently omitted the tax.

3.    Self-report use tax on your Combined Excise Tax Return if vendors legitimately cannot charge sales tax.

The Combined Excise Tax Return

Washington does not have a state income tax. Instead, businesses file a Combined Excise Tax Return that includes:

       Business & Occupation (B&O) Tax – A gross receipts tax on business activities

       Retail Sales Tax – Tax collected from customers on taxable sales

       Use Tax – Self-reported tax on out-of-state or untaxed purchases

       Other applicable state and local taxes

All registered Washington businesses must file this return, even if they had no business activity during the reporting period. This is known as a “no business activity” return.

Filing Frequencies and Due Dates

The Department of Revenue assigns filing frequencies based on your estimated annual tax liability:

Filing Frequency

Business Size

Due Date

Monthly

Higher volume businesses

25th of following month

Quarterly

Mid-range businesses

Last day of month after quarter

Annual

Smaller businesses

April 15 / January 31

Note: Due dates falling on weekends or holidays extend to the next business day.

Late Filing and Payment Penalties

Timely filing is crucial to avoid escalating penalties. Here’s what you can expect if you miss your deadlines:

Timing

Penalty

After due date

9%

After last day of following month

19%

After 2nd month following due date

29%

Interest (2025 rate)

7% annually

Additionally, interest accrues at approximately 7% annually (2025 rate) on unpaid tax balances.

Next Steps for Your Business

Staying compliant with Washington’s sales and use tax requirements requires ongoing attention, especially with the recent legislative changes. We recommend reviewing your current practices, auditing your vendor invoices for proper tax collection, and ensuring your bookkeeping processes capture any use tax obligations.

If you work with a bookkeeping team, make sure to notify them of any invoices requiring use tax treatment so they can properly record the expense and include the tax on your next excise tax return.

Disclaimer

This article is for informational and educational purposes only and should not be construed as specific accounting, legal, or tax advice. Tax laws and interpretations may change, and specific situations may warrant different approaches. The information provided herein does not create a client relationship and is not a substitute for professional consultation. Please consult with a qualified accounting professional to discuss how these requirements apply to your specific circumstances.

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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

How to Complete Your 401(k) Annual Census: A Step-by-Step Checklist

If your company sponsors a 401(k) plan, submitting accurate annual census data to your Third-Party Administrator (TPA) is one of the most important tasks in your retirement plan administration process. This data drives everything from employer match calculations to required 401k compliance testing—and delays can lead to costly errors.

In this guide, we’ll walk you through exactly what information your TPA needs and how to ensure your TPA census submission is complete and on time.

What Is a 401(k) Annual Census?

A 401(k) annual census is a comprehensive report of employee data that your TPA uses to:

  • Perform required compliance testing (ADP, ACP, top-heavy tests)
  • Calculate employer matching contributions accurately
  • Determine participant vesting percentages
  • Identify highly compensated employees (HCEs) and key employees
  • Prepare your plan’s annual Form 5500 filing

The census includes data for all employees—not just those participating in the plan—because eligibility and testing requirements apply company-wide.

What to Include in Your 401k Census Checklist

While specific requirements may vary based on your plan document, most TPA census submissions require the following categories of information.

  1. Employee Identifying Information

For every employee on your payroll during the plan year, provide:

  • Full legal name
  • Social Security number or employee ID
  • Date of birth
  • Original date of hire (even if the employee was rehired)
  • Termination date and/or rehire date, if applicable
  • Current employment status (active, terminated, retired, deceased, on leave)
  1. Compensation Data

Compensation figures are critical for employer match calculations and compliance testing. Be sure to use the compensation definition specified in your plan document, which may differ from W-2 wages.

  • Gross compensation for the plan year
  • Bonuses, overtime, and commissions (if tracked separately per plan terms)
  1. Hours and Service Information

Hours worked are essential for determining eligibility and vesting. Even salaried employees may need hours tracked depending on your plan’s requirements.

  • Total hours worked during the plan year
  • Hours for part-time and salaried/exempt employees
  1. Ownership and Related Party Information

This information is used to identify highly compensated employees (HCEs) and key employees for 401k compliance testing.

  • Ownership percentage for each owner
  • Family relationships to owners (spouse, child, parent, grandparent)
  • Controlled group or affiliated service group details, if applicable
  1. Deferral and Contribution Data

Include payroll-related contribution information:

  • Pre-tax deferral amounts by employee
  • Roth deferral amounts by employee
  • Catch-up contributions for employees age 50 and older
  • Loan repayments processed through payroll (if applicable)

Common 401(k) Census Mistakes to Avoid

Even experienced plan sponsors can make errors in their retirement plan census submissions. Watch out for these common pitfalls:

  • Omitting terminated employees — They must still be reported for the plan year.
  • Using the wrong compensation definition — Always refer to your plan document.
  • Excluding hours for salaried employees — Many plans still require this data.
  • Outdated ownership percentages — Update after any business changes.
  • Late submissions — This delays compliance testing and contribution calculations.

5 Tips for a Smooth TPA Census Submission

  1. Request your TPA’s census template early — Each TPA may have specific formatting requirements.
  2. Coordinate with your payroll provider — Many payroll systems can export census data in the required format.
  3. Review data for accuracy before submitting — Double-check compensation figures and employee counts.
  4. Include all employees — Even those who didn’t participate or who terminated during the year.
  5. Submit as early as possible — This allows time for questions, corrections, and timely filings.

Why Timing Matters for Your 401k Plan Administration

Your TPA manages census data for many plans simultaneously during peak filing season. Submitting your 401(k) annual census promptly ensures your plan receives the attention it needs and helps avoid:

  • Delayed employer contribution calculations
  • Rushed compliance testing that may miss errors
  • Late Form 5500 filings and potential penalties
  • Additional stress during an already busy time

Next Steps

Completing your 401k census checklist doesn’t have to be overwhelming. Start by contacting your TPA to confirm their specific requirements, then work with your payroll provider to gather the necessary data.

If you have questions about preparing your retirement plan census or need assistance with your 401k plan administration, contact your TPA for guidance.

Disclaimer: This article is provided for general informational and educational purposes only and does not constitute legal, tax, or professional advice. Plan requirements vary based on individual plan documents and applicable regulations. Please consult with your TPA, legal counsel, or qualified retirement plan advisor for guidance specific to your situation. This content is intended to assist with understanding 401(k) census requirements but does not guarantee compliance with ERISA, IRS, or DOL requirements.

401(k) Annual Census Submission Checklist: Click Here to access a copy of the below checklist resource in PDF format.

Use this checklist to ensure you submit complete and accurate census data to your Third-Party Administrator (TPA). Timely submission helps ensure accurate contribution calculations, proper compliance testing, and on-time Form 5500 filing.

Section 1: Employee Identifying Information

Provide the following for ALL employees—not just plan participants:

 

Employee Identifying Information

Full legal name

Social Security number (or employee ID)

Date of birth

Date of hire (original hire date, even if rehired)

Date of termination, if applicable

Date of rehire, if applicable

Employment status (active, terminated, deceased, retired, on leave)

Section 2: Compensation Data

Compensation must match the definition in your plan document, which may differ from W-2 wages:

 

Compensation Data

Gross compensation for the plan year (per plan document definition)

Bonus amounts (if tracked separately per plan terms)

Overtime pay (if tracked separately per plan terms)

Commissions (if tracked separately per plan terms)

Section 3: Hours and Service Information

Hours are required for eligibility and vesting calculations, even for salaried employees:

 

Service Information

Total hours worked during the plan year

Hours tracked for salaried/exempt employees (if required by plan)

Hours for part-time employees

Section 4: Ownership and Related Party Information

Required for highly compensated employee (HCE) and key employee testing:

 

Ownership Information

Ownership percentage for each owner

Family relationships to owners (spouse, child, parent, grandparent)

Any changes in ownership during the plan year

Controlled group or affiliated service group information (if applicable)

Section 5: Deferral and Contribution Data

Provide payroll-related contribution information:

 

Contribution Data

Pre-tax deferral amounts by employee

Roth deferral amounts by employee

Catch-up contributions (for employees age 50+)

Loan repayments processed through payroll (if applicable)

Section 6: Before You Submit

 

Final Review

Verify ALL employees are included (including terminated employees)

Confirm compensation definition matches plan document

Review ownership percentages for accuracy

Use TPA’s preferred format or template

Submit data to TPA ASAP to ensure timely filings

Helpful Tips

Contact your TPA early to request their specific census template.

Coordinate with your payroll provider to export data in the required format.

Don’t forget terminated employees — they must be reported for the plan year.

Submit early to allow time for questions and corrections.

Questions? Contact your TPA for assistance.

Disclaimer: This checklist is provided for general informational and educational purposes only and does not constitute legal, tax, or professional advice. Plan requirements vary based on plan documents and applicable regulations. Please consult with your TPA, legal counsel, or qualified retirement plan advisor for guidance specific to your plan. This document is intended to assist with compliance but does not guarantee compliance with ERISA, IRS, or DOL requirements.

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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

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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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

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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STUDY CLUBS

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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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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

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

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

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

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

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:

  • 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

Author: Kevin J. Bray, Partner @ The Dental Accounting Group


Starting in 2020, Washington Delta Dental (DDWA) introduced pivotal changes to its Provider Reimbursement Model (PRM), designed to address the economic challenges and feedback from dental care providers across the state. This collaborative approach has culminated in a revised system that’s attempting to meet the economic and clinical demands of tomorrow.

As we head into 2024, Washington Delta Dental (DDWA) will introduce another update to their Provider Reimbursement Model (PRM), promising to help the financial underpinning of dental practices. But the question on every practitioner’s mind is straightforward: are these adjustments a beacon of progress or merely a drop in the ocean of economic necessity?

DDWA PRM Overview

Credit: Delta Dental of Washington

The Promise of Progress

DDWA has pledged a significant investment in reimbursement enhancements, with an estimated $100M earmarked for provider compensation. Additionally, the model now promises to bring about “an increase to your rung score” for 60% of practices on the PRM, ensuring no decreases in fees from the previous year.

The revised PRM marks a significant departure from the status quo, responding to practitioner feedback with a series of strategic enhancements. The highlight is a 5% increase in select hygiene codes, projected to deliver an “overall average annual increase of approximately $5K for each eligible practice.” This is complemented by a shift from a 10-year to a 2-year look-back period for Continuity of Care metrics, reflecting a pragmatic approach to measuring practice performance. Furthermore, DDWA has taken a commendable step towards equity by integrating the “Ultra-Rural” market type into the PRM, aiming to level the playing field for practices across diverse geographic locales.

DDWA PRM Timeline for Inflationary Increases

Credit: Delta Dental of Washington

The Economic Realities

Despite DDWA’s proactive stance, the adequacy of the 5% increase is under intense scrutiny. With overhead costs skyrocketing and hygienist wages in metropolitan areas like Seattle nearing $75 per hour, the incremental raise falls short of what is needed to navigate the economic currents of 2024 and beyond. The hygiene department is not only central to patient care but also to the financial health of a practice. As such, practice owners are advocating for further increases in hygiene reimbursements. This would enable them to pay competitive market wages to hygienists, maintain the quality of patient care, and ensure the profitability of their hygiene department. The delicate balance between fair compensation and operational sustainability is critical. Without additional adjustments to the reimbursement model that account for the steep rise in labor costs, particularly in metropolitan areas, practice owners may find it increasingly difficult to manage profitability while upholding the highest standards of patient care. The adjustment, although a positive acknowledgment, does not fully mitigate the escalating expenses in supplies, services, utilities, and equipment that are outstripping general inflation rates. Therefore, a call to action is clear: future iterations of the PRM must consider more substantial increases in  reimbursements to ensure the vitality and success of dental practices.

2023 DAG Client Survey Staffing Cost %​

2023 dag client survey staffing cost percentage

© 2023 DG Accounting Professionals LLC.

Staffing costs continue to grow in real dollars and eat up a greater portion of the overall overhead. Many practices are watching total staff costs rise to nearly 40% of their revenue as staff wages increase and revenue remains stagnant.

2023 DAG Client Survey Profit Margin %

2023 dag client survey profit margin percentage

© 2023 DG Accounting Professionals LLC.

Profit margins before associate pay have dropped in recent years mainly due to wage inflation and other rising costs of doing business in urban metropolitan areas. Practices across the board saw roughly a -5% decline in profits YOY.  

A Tale of Two Practices

The disparity between urban and rural practices remains a critical subplot in this narrative. While the new model intends to harmonize this imbalance, rural practices continue to navigate unique challenges that a universal model might not fully address. Meanwhile, urban practices grapple with a competitive job market and elevated living costs. The “Ultra-Rural” adjustment, although well-intentioned, could still leave certain practices grappling with financial sustainability. The implications of these changes are far-reaching. Dental practices across Washington can anticipate a more equitable reimbursement scenario. By integrating “ultra-rural” market type and adjusting targets to the 95th percentile per market, DDWA aims for a fair comparison among peers, fostering a level playing field for all practices, irrespective of their size or location​​.

New Ultra Rural Market Types Added:

DDWA PRM New Ultra Rural Market Types

Credit: Delta Dental of Washington

Summary of Key Modifications Taking Effect

In the spirit of transparency and to aid providers in understanding the impending modifications, DDWA has offered a detailed glimpse into the changes:

  • Inflationary Adjustments: A 5% increase on select hygiene codes for participating providers will be instituted. This adjustment is a strategic move to counteract inflationary pressures but falls short of the needs of the average practice. The overall average annual increase is only approximately $5K for each eligible practice. This is hardly an “inflationary adjustment” considering wage inflation alone for full-time hygienists has increased on average 15% during the last two years.
  • Simplified Metrics & Feedback-Driven Revisions: The PRM will adopt simplified metrics for assessing practice performance. For instance, the retention metric has been revamped to a “Continuity of Care” standard, focusing on a 2-year look-back period, down from the previous 10-year span, to better align with practice realities.
  • Expansion of Eligibility: With the PRM modifications, a significant “68% of practices on the PRM will experience a score increase and an additional average annual projected increase of ~$9K per practice”.
  • Fee Schedule Updates: Providers will see their new fee schedules on the Provider Portal, which will automatically reflect the changes for 2024.
  • Inclusive Model Adjustments: Modifications will affect all four inputs—practice costs, prevention, access, and retention—streamlining the metrics for better clarity and ease of management.
  • Prevention-Centric Increases: There is a special focus on preventive procedures, with a 5% inflationary increase on codes such as D1110 (adult cleaning) and D1120 (child cleaning), which are essential to maintaining oral health.

A Future in Flux

Looking ahead, the true impact of the PRM changes will only be measurable in hindsight. While the modifications are a testament to DDWA’s commitment to iterative improvement and stakeholder engagement, the sustainability of dental practices hinges on the alignment of reimbursement rates with the dynamic economic landscape. As practitioners and DDWA alike navigate these changes, ongoing dialogue and flexibility will be crucial in ensuring that the PRM evolves in step with the real-world financial demands of dental care.

Conclusion: Caution Meets Optimism

In conclusion, while DDWA’s PRM updates for 2024 mark a significant step towards addressing the economic challenges faced by dental practitioners, there’s a palpable sense of caution. Is a 5% increase sufficient to keep up with wage inflation and the ever-growing overhead costs? Will these changes truly bridge the gap between rural and urban practice economics? And importantly, will the revisions enable practice owners to sustainably compensate their team and ensure profitability?

From our perspective, the increases fall short. Based on our 2023 DAG client survey, hygiene wages increased more than 15% during the last two years, which is roughly a $17k-$20k payroll increase per full-time hygienist. If an average practice is doing $1m in collections and they are only seeing a $5k bump as an inflationary adjustment, it’s clearly falling short of the economic demands of a traditional practice staff model. Time will tell if these changes herald a new era of financial prosperity or if they serve as a precursor to a more comprehensive overhaul that many practitioners believe is necessary. What is clear is that the dental community must remain vigilant, adaptive, and vocal to ensure that their economic needs are met not just in 2024, but in the years that follow.

Author’s note: This article merges two perspectives into a comprehensive narrative, weighing the optimism surrounding DDWA’s PRM changes against the skepticism of whether they go far enough in addressing the real economic pressures of dental practices. It offers a balanced view that acknowledges the effort while calling attention to the reality of the financial challenges that lie ahead. The Dental Accounting Group is a fierce advocate for dental practice owners. We will continue to analyze this reimbursement model in the years to come and voice our perspective to DDWA.

 

Questions? Refer to your new Delta Dental PRM portal to see the economic impact on your practice. They’ve also added a new glossary of terms:

Additional Reimbursement Resources:

Additional DDWA PRM Resources

Credit: Delta Dental of Washington

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