The Impact of Self-Pay On Revenue Cycle Management

Thumbnail Self Pay

The numbers don’t lie.  In fact, they paint a grim picture for the affordability and sustainability in healthcare.  During COVID, millions of Americans lost their employer sponsored health insurance when they lost their jobs.  Estimates suggest that about 40% of adults under age 65 are not adequately insured and that nearly half can’t afford to pay their out of pocket expenses.

In 2000, patient payments accounted for less than 5% of total provider revenue. By 2017, it had risen to 35% and continues to increase, leaving an average health system with about $45M in bad debt.  Self-pay dollars are hard to collect.  Today, there is about a 55% collection rate on a growing balance.  Because of the shift toward consumer payments, providers are inheriting the risk of inability to collect those dollars.  Effective revenue cycle management has never been more relevant.

Managing self-pay accounts takes a multi-faceted approach.  Identifying accounts that have not had payments or adjustments in the last 90 days is the first step.  Then understanding who can make partial payments, who would pay the full balance if financing options were available, those who qualify for financial assistance and which accounts should be classified as bad debt is critical.  That segmentation then allows the accounts to be prioritized so that the revenue cycle staff can work those most likely to be collected.  In turn, that dramatically improves net realization of cash from patient pay receivables.  

Hope is not a strategy.  Designing an effective operational program to collect self-pay dollars is complex.  Having expert partners that have seen organizations across the country succeed in increasing their self-pay collections is a true asset.  Kind of like the commercial, we know a thing or two because we’ve seen a thing or two and we are here to help.

Interested in learning more? The team at VisiQuate is focusing on how we can help hospitals optimize their revenue cycle management. Visit our Revenue Cycle Playbook for step-by-step plays to help you stay on top of the ever-changing landscape of healthcare revenue cycle, or contact us to schedule a demo.

Other featured posts

See why we say You'll see.®