Patient pay has steadily declined since the pandemic. From January 2018 through February 2020, mean repayment rates were 54%; by 2023, they dropped by nearly 10%. Repayment rates fell further for medical bills over $1,000, dropping below 35%. Bills around $100 didn’t fare much better in 2023, averaging 50%.2
But medical billing is a different story. It’s a complex web of patients, providers, insurance carriers, and revenue cycle management (RCM) companies, where outstanding patient pay after insurance is often undercollected, and the resulting unpaid balances are written off as bad debt at practice expense.
Bad debt adds up fast. In an analysis of over 1,850 hospitals and 350,000 physicians, patient responsibility accounted for $1.1 billion of $5 billion in total payments received. Patient pay rates dropped from 54.8% in 2021 to 47.8% in 2022-2023 as providers collected about $500.5 million, amounting to half of what was owed. Lower collection rates resulted in over $17.4 billion in bad debt; approximately 53% of it came from insured patients.1
A focused patient pay approach can help improve patient AR collection rates.
The RCM Conundrum
While RCMs focus on a practice’s revenue, that doesn’t necessarily mean they focus on patient pay after insurance adjudication.
For most practices, it takes anywhere from 30 to 90 days for bills to get resolved. RCMs working with practices get a percentage of all claims, including clean and unresolved; this gives RCMs little incentive to collect outstanding AR.2
When uncollected patient pay shifts from potential money in the bank to bad debt, RCMs still get paid either way; the same can’t be said for the practices they represent.
Addressing Outstanding Patient AR with Patient Billing Satisfaction
Practices need revenue management to collect on outstanding AR. They need a reliable patient AR optimization and resolution partner who knows how to engage with patients directly, addressing account reconciliation with proven patient pay solutions.
And they can find that partner with PatientFocus.
PatientFocus acts as an extension of their revenue cycle itself. Using a proprietary patient AR optimization platform that resolves balances after insurance, we engage patients directly with end-to-end patient balance resolution, combining smart outreach with real patient support.
By prioritizing the patient financial experience, we’ve helped practices achieve:
- 40% increase in patient pay revenue4
- 28% decrease in days in AR4
- Payments in as little as seven days, with an average turnaround of 11 days4
Our post-insurance adjudication expertise has also helped practices cover our fees using found insurance. Combined with a $0 out-of-pocket startup cost, partnering with PatientFocus offers practices a fast, effective way to address outstanding patient AR.
Get in touch to see how we can help transform uncollected patient pay into positive cash flow for your practice.
Sources
- Taylor, Mariah. “Patient Collections Fall to 48%.” Becker’s Hospital Review, February 29, 2024. https://www.beckershospitalreview.com/finance/patient-collections-fall-to-48
- Ippolito, B., Trish, E., et al. “Patient Repayment of US Hospital Bills From 2018 to 2024.” JAMA Health Forum 6, no. 8 (August 8, 2025): e252284. https://doi.org/10.1001/jamahealthforum.2025.2284
- Siwicki, Bill. “One Practice Fixed a Broken Rev Cycle Model, and Now Gets Cash in 12 Days Instead of 90.” Healthcare IT News, May 12, 2026. https://www.healthcareitnews.com/news/one-practice-fixed-broken-rev-cycle-model-and-now-gets-cash-12-days-instead-90
- Internal data on file: PatientFocus.