Fractional CFO and business advisor for orthodontic practices
In ortho, the contract is signed today and the money arrives over the next two years. That gap is where most of the financial confusion lives.
Sound familiar?
Common orthodontic practice financial challenges
Ortho runs on a different clock than the rest of dentistry. A case starts, the contract gets signed, and the money arrives in monthly installments. Meanwhile, brackets, aligners, lab fees, and payroll all want paying now.
Why orthodontic practice finances feel so complicated
The question nobody asks about case starts
Most ortho owners ask how to get more starts. The more useful question is what happens to a start after the contract is signed.
You’re a lender now.
Every in-house payment plan is a small loan. Most families pay on time. The ones who stop paying in month nine don’t show up as a problem until much later, and by then the balance is a lot harder to collect.
Production and cash don’t match.
Depending on how your books are set up, a big month of starts can look fantastic on paper while the actual cash trickles in over 18 to 24 months. Hiring or buying equipment off the paper number is how practices end up tight.
Costs come first.
Aligners, lab fees, and supplies tend to hit at the start of treatment. The payments that cover them come later.
Referrals are your pipeline.
When a referring dentist slows down, it shows up in starts first and cash a few months later.
Insurance works differently here.
Orthodontic benefits usually pay out over the course of treatment, and many plans cap them with a lifetime maximum. Eligibility can change mid-treatment, too. A parent changes jobs, coverage changes, and if nobody catches it, the patient balance quietly grows.
None of this is a management failure. It’s the business model.
Where my background comes in
Why an insurance background matters in ortho
I spent ten years in healthcare finance, including health insurance and workers’ compensation. I saw how benefits pay out over time, stop when a maximum is reached, and change when eligibility does. Ortho claims follow those same rules, and that’s where payments quietly go missing.
I also started chairside as a certified dental assistant. I know what a surgical day looks like from inside the operatory, and what it costs when it runs long.
Put those together and you get a different view. Most CFOs look at your practice from the books outward. I look at it from the chair, the claim, and the books, and how each one affects the others.
Your orthodontic fractional CFO
What changes with orthodontic business advisory support
You know what’s still coming in. Open contract balances and expected payments, in one clear picture, so cash flow stops being a guessing game.
You know what a start is actually worth. What each case costs you to deliver, and what it earns after lab fees, supplies, and chair time.
Late payments get caught early. Payment plan and insurance gaps get flagged in month two, not month twelve.
Your fees keep up with your costs. Benchmarked against practices like yours, not a number set five years ago.
Big decisions get a financial case. A second location, a new associate, a partner buy-in, or a DSO conversation, made with real numbers behind them.
How it works
How our orthodontic CFO advisory process works
FAQ
Orthodontic practice CFO FAQ
Do you work with orthodontic practices specifically?
Can you help me understand what’s owed on our open contracts?
Should we offer in-house financing or use a third-party lender?
How do I know if my fees are keeping up with my lab costs?
A DSO has approached me. Can you help?
Thirty minutes for an honest conversation about your practice and whether Keystone is the right fit.