Managing self-pay patients to boost collections

A helpful guide to collecting balances from self-pay patients

Collecting patient balances is a vital part of a practice’s revenue cycle, whether it’s co-pays due at the time of service, post-claim collections after a payer has been billed, or payments from self-pay patients who are responsible for the full cost of their care.

But collecting what’s owed from patients isn’t always easy, especially in situations where patients are uninsured or have high-deductible health plans. In fact, data from a study of 1,850 hospitals and 250,000 physicians shows that the average patient collection rate was just 47.6%.¹ That leaves over 50% of patient payments uncollected after the time of care.

Practices today face strain and challenges in staying on top of patient balances. The amount owed by a patient can include co-pays, deductibles, and co-insurance depending on the patient's financial responsibility, or for self-pay patients, the entire cost of care. These payments from patients account for a critical portion of a practice’s annual revenue. The collections process itself can be expensive — costing practices thousands to even millions annually, depending on size — with the average cost to collect ranging from 3-4% of total revenue.²

To help reduce outstanding balances, improve cash flow, and decrease administrative costs to collect, patient and self-pay balances should be managed as part of your practice’s daily revenue cycle management workflow.

We’ll walk you through some best practices, informed by insights from our network of over 160K physicians across the U.S., to help you collect patient balances and improve collection rates.³

Key considerations for managing patient payments

Efficient patient collections start with a strategic and thoughtful approach that’s applied to every stage of the healthcare revenue cycle.

1. Collect at time of care: Collecting payments early in a patient visit is vital, such as during check-in before the patient receives care. To make this easier, keeping a credit card on file for each patient can help eliminate the need to chase these payments down later. Ensure patients know their card will be charged at the time of service. Tip: Make this a part of your standard intake forms, so it’s baked into the process for every patient.

2. Set clear expectations: Let patients know about their copays, deductibles, and any outstanding balances before their visit. While a practice will bill insurance, it’s ultimately the patient’s responsibility to understand what they owe. Clear communication at the start will help avoid future confusion and build trust with the patient.

3. Empower staff to collect: Some team members, whether they’re front office staff or part of a medical billing department, are more comfortable asking for payments. Identify these individuals and position them to handle critical points in the revenue cycle. Make sure they’re easily available to support patients during sensitive financial discussions.

4. Leverage HIT software: Utilizing tools within HIT and revenue cycle management software can help your practice identify crucial baseline metrics like A/R Days, Patient Pay Yield (PPY), and Cost to Collect. Keeping an eye on these important RCM benchmarks can help your practice set realistic revenue goals and stay on track financially.

Setting the right policies for collections at check-in

Clear, proactive communication about financial responsibilities builds trust, improves operations, and helps reduce outstanding balances. Establishing transparent payment expectations early — ideally during intake — sets the tone for a smoother revenue cycle. Insurance verification tools can also help by letting patients know their expected co-pay before their visit.

When patients understand what they owe, they’re more likely to come prepared to pay at the time of their appointment.

When RCM is baked into your practice’s daily workflow, it becomes easier and more efficient to manage

Integrating self-pay collections into the day-to-day healthcare revenue cycle

Revenue cycle management in healthcare oversees the financial journey of patient care, from the moment a patient walks in to when a final payment is received, so it’s important to integrate in every stage of the visit. When RCM is baked into your practice’s daily workflow, it becomes easier and more efficient to manage.

Follow these tips at each stage to make collecting patient balances run more smoothly:

Pre-visit scheduling:

• Create clear policies that outline payment expectations, including guidance for those who may be uninsured or underinsured. Share this information in visible places like a sign at your check-in desk, a notice on your practice’s website, or a link in an appointment confirmation email. Making it easy for patients to access these policies helps set expectations and reduce the risk of financial misunderstandings later on.

• Confirm correct insurance information several days before the patient’s appointment. Reminder texts and emails can include info about copays and any outstanding balances due. AI-powered insurance selection and automated eligibility checks can help accurately capture a patient’s insurance information, saving time and resources for your team.

• Additionally, Good Faith Estimates, required under the No Surprises Act, play a critical role in the pre-visit process for uninsured and self-pay patients. These estimates allow front-office staff to have transparent financial conversations and help ensure patients understand their responsibilities upfront.

Check-in:

• Verify the patient’s demographic and insurance information. If a patient’s status is “unverified” or “ineligible,” front office staff should address this by asking for corrected insurance information or labeling the patient as self-pay.

• Ensure all necessary forms — financial policy, consent to treatment, and patient rights and responsibilities forms — are completed at check in. Just over 40% of patients currently use digital tools to complete healthcare paperwork.⁴ Surfacing these forms via an early check-in email or their patient portal can make sure that all forms are completed and all necessary information is captured before the appointment.

• Based on your practice’s policies and consent forms, and the patient’s financial responsibility, your practice should collect copays, deductibles, and any previous balances that may be due. Remember: keeping a credit card on file is a general best practice for streamlining this process and reducing later collections challenges.

Post-visit:

• Almost one in three patients (28%) use digital engagement tools to make electronic payments.⁵ Helpful reminders via text, email, and patient portal messages about outstanding patient balances can ensure patients remain aware of their financial responsibility. 

• To make the payment process easier, offer flexible options beyond traditional credit cards such as checks, FSA/HSA cards, and payment plans. Patients may also wish to discuss installment options with medical billing staff to ensure they can manage their balances comfortably.

Rapid follow-up for unpaid balances

As many practice managers, medical billers, and doctor-owners know, the RCM work doesn’t stop once a patient leaves. Timely follow-up after care is essential, so patient balances aren’t overlooked or left unpaid.

Here are a few tips to help you track and collect outstanding patient balances:

• Automated reminders: Your patients are already digitally engaged in their daily life. Automated reminders about outstanding balances through texts, emails, and patient portal notifications can help keep these balances top of mind – and make it easier for patients to pay. Be sure to use these digital patient engagement tools to your advantage.

• Personalized outreach: If automated digital reminders aren’t effective, have medical billing or RCM staff follow up with a phone call to notify self-pay patients of their balance and collect payment directly.

• RCM tracking and measurement: Revenue cycle metrics like Collections Posted and Charges Posted enable your team to measure cash received vs. cash due, helping you maintain momentum month over month.

If a patient misses a payment or falls behind, compassionate follow-up gives them the opportunity to get back on track while also helping your practice collect payment for the care you’ve delivered.

The role of technology in patient payments collection

To overcome challenges with collecting patient balances, look for user-friendly digital tools and an integrated platform that combines RCM software with patient engagement tools and medical billing services. Let’s explore how the right system, like athenaOne® revenue cycle management, can help your practice succeed:

• Automated claim submissions and payment posting to lower administrative costs and help staff focus on patient care.

• Automated billing rules engine to help ensure claims are accurate the first time they’re submitted, identifying potential claim issues in real time.

• Enhanced Claims Resolution helps take on the work of denied claims to help get them approved and your practice paid.

• Insurance eligibility checks and verification to confirm patient coverage help minimize errors and denials.

• Insights Dashboards help your practice regularly track Patient Pay Yield, Collections Posted, Charges Posted, Patient Collection Rate, and more so your practice can effectively measure financial health.

• athenaPatient™ app helps patients submit digital payments easily and alerts patients when a payment is due. Enabling this feature is a good best practice to help patients stay on top of their responsibilities.

• The patient portal lets patients easily view and pay bills online, with helpful reminders when a balance is due.

athenahealth’s RCM services have the power to help many practices and specialties to collect more, while saving valuable time. One urgent care practice saw a 52% increase in Patient Pay Yield and a 26% decrease in time to bill using athenaOne and by partnering with a Customer Success Manager.⁶

Teaming up with a vendor like athenahealth cuts down on billing headaches and boosts patient collections — so your staff can stop chasing payments and start focusing on running a smoother, more responsive practice.

Build a better system for managing self-pay patients and collecting balances

Successfully managing self-pay patients and collecting overdue balances requires a consistent approach that begins before the visit and continues well after checkout.

By following patient payment best practices like setting clear financial policies, maintaining an active card on file, collecting payments at check-in, and offering flexible payment options, your practice can help improve the overall collections process and revenue cycle. Setting a defined strategy and leveraging RCM tools like athenaOne help your practice work towards clearer expectations, more trust with patients, better financial outcomes, and less stress for both patients and practice staff.

Need help managing patient collections? See how our customer, Advanced Urgent Care, was able to achieve easier, quicker patient payments with athenahealth.