Editor’s note: This article builds on themes first explored in Maximizing Patient Collections through Trained Staff and Informed Consumers, an ACMPE Fellowship paper by Debra Clamp, FACMPE (July 2017). The five competencies in the companion checklist adapt the paper's five-week training roadmap. The analysis, data and recommendations here are new.

A patient can check in, pay the copay and still leave owing much more. Without a pre-visit estimate, the receptionist may not know what the patient will owe toward the deductible. In a 2025 MGMA DataDive report, practices collected about 72% of copayments at the visit but only 26.83% of other patient balances.¹ In 2025, 88% of workers with single coverage had a deductible averaging $1,886.²

That money becomes harder to collect after the patient leaves. Kodiak Solutions reported that hospitals and practices in its database collected 30.07% of the self-pay portion of insured patients' claims in early 2026.³

The response starts before check-in: estimate the patient's share, train staff to explain it and offer ways to pay, and set clear cash prices for patients not using insurance.

Why the old collections playbook falls short

A routine visit can become a major expense. The average deductible for 2026 marketplace selections reached $3,786, up 37%.⁴ Cost already affects access: 17% of adults delayed or skipped care or prescriptions because of cost in 2024.⁵

A familiar patient may have unfamiliar coverage. The uninsured rate was 8.3% in 2025, yet paid-up marketplace enrollment fell 13% by February 2026.⁶^,⁷ Starting with renewals on or after Jan. 1, 2027, Medicaid expansion enrollees face six-month renewals, with community engagement requirements for some.⁸ Check benefits again before the visit.

Even insured balances can become bad debt. More than half of bad-debt write-offs in Kodiak's 2024 data involved insured patients.⁹ Staff need a plan for that balance before it turns into another collection task.

An estimate can be a legal requirement. Federal rules require written good faith estimates for uninsured and self-pay patients when scheduling or request conditions apply. A provider bill at least $400 above its estimate may qualify for dispute.¹⁰ The advanced explanation of benefits requirement for insured patients remains unimplemented as of this draft.¹¹

Technology makes earlier estimates possible. Eligibility checks and contracted-rate data help staff anticipate the patient's share, and practices can send a secure payment link before the visit. Someone still needs to explain unclear benefits and changed estimates.¹²

Cash pay needs its own policy. Concierge and direct primary care sites grew 83% from 2018 to 2023.¹³ Patients choosing not to use insurance need a clear price, not an improvised discount.