An Oct. 21, 2025 MGMA Stat poll found that 66% of medical group leaders report their practices’ patient balance collections are about the same (40%) or better (26%) at this point in 2025 versus last year, while 29% said they are worse and another 5% were unsure. The poll had 247 applicable responses.
What you told us
Practices that improved patient balance collections most often cited tightening front-end processes — emphasizing time-of-service (TOS) collections, clearer estimates, and stronger accountability for registration and billing staff. Many added or switched vendors for text reminders, payment portals, or RCM services, while others introduced staff incentives, better training, or proactive outreach on past-due accounts. A smaller share adopted new policies such as collecting self-pay in advance or requiring deposits for certain services.
However, these approaches are not guaranteed to work. One practice leader noted that text messages to patients did not work because many were wary of texts possibly being scams.
Groups reporting steady patient balance collection performance in 2025 largely maintained familiar approaches — using text or email reminders, online payment tools, and front-desk collections. Some added vendors, expanded payment plans, or retrained staff, but overall their adjustments produced stable rather than improved results.
Practices that saw worse patient balance collections frequently mentioned relying on the same tools as others — text reminders, payment plans, and credit cards on file — but often alongside staffing disruptions, vendor changes, or system conversions that disrupted consistency. Several cited external pressures such as higher deductibles or economic hardship among patients, suggesting that even well-intended process updates struggled against larger operational and financial headwinds.
The signal behind these numbers is becoming clearer in MGMA data and across the industry: practices that collect earlier and reduce “touches” are outperforming peers, while macro forces such as consumer cost-sharing, cyber risk, and payment friction are raising the bar for revenue cycle management (RCM).
What the data says right now
- Collect early or chase longer. MGMA’s benchmarking data shows how much happens (or doesn’t) at the front desk. TOS copay collection fell from about 90% pre-pandemic (2019) to 56% in 2022, even as TOS collection of patient-due balances rose from about 15% (2019) to 39% (2022). Top-performing groups also concentrate a larger share of A/R in the first 30 days and carry less in 120+ days.
- Operating costs keep climbing. Nine in 10 medical groups reported higher year-to-date operating costs in 2025, with an 11% average increase, tightening cash needs and shortening organizations’ tolerance for slow-moving patient A/R.
- Measure more than “days in A/R.” A newer lens is “zero-touch rate” — the share of claims paid with no human intervention. Industry experience pegs only about 40% of claims as zero-touch; each extra “touch” adds labor cost and delays cash. Building RCM reporting around touches and cost-to-collect exposes where work piles up and why cash slows.
Other major factors
- Patients owe more out of pocket. In 2024, 87% of covered workers had a general annual deductible; among those with a deductible, the average single deductible was $1,787, and 32% were in plans with $2,000-plus deductibles — all of which pushes balances to patients.
- Credit-reporting leverage has changed. The CFPB’s January 2025 rule to remove medical bills from credit reports was struck down by a federal court in July 2025, leaving no nationwide standard. However, the major credit bureaus had already stopped reporting most paid or sub-$500 medical debts in 2023 and continue those voluntary limits. The result is a patchwork of state rules and fewer credit-score consequences for nonpayment — making upfront cost transparency and patient engagement more essential.
- Cyber disruption lingers. The 2024 Change Healthcare attack broke claims, eligibility, and payment workflows nationwide. CMS temporarily advanced up to 30 days of payments through the CHOPD program, then ended the relief by July 12, 2024 — leaving practices to work down backlogs and reconcile. Community health centers reported ongoing reimbursement red tape months later. If your 2025 A/R still shows “lumpiness,” this is part of the story.
- Payment friction remains real. Many groups still face insurer or vendor-imposed fees for electronic payments (e.g., virtual cards, percentage EFT fees), eroding net collections. In a late-2023 MGMA Stat poll, 60% said they were being charged fees they did not agree to, often totaling 2% to 3%.
What to do next
- Tighten the front end. Standardize eligibility checks and estimates for every scheduled visit. Collect copays and any known patient-due amounts at TOS; for elective services, use deposits. Provide the federally required Good Faith Estimate to uninsured/self-pay patients and document the process; train staff to use it as a conversation tool, not a script.
- Offer flexibility without creating drag. More than 4 in 10 practices updated patient payment options last year, often tightening plan terms while expanding digital options (text-to-pay, portals, autopay). Define minimums (e.g., auto-draft, capped plan duration), and route hardship cases to a formal financial-assistance pathway to preserve access.
- Segment patient A/R on Day 1. When possible, use propensity-to-pay indicators and clinical context to decide early whether an account should go to: (a) automated reminders and self-service; (b) staff outreach; or (c) financial counseling for charity/discount screening. Set service-level agreements for each queue (e.g., “first statement paid” target, call attempts, escalation timing).
- Shorten the statement cycle. If you still mail three paper bills 30 days apart, you are financing your receivables. Move to digital-first statements, weekly small-balance sweeps, and payment links in all reminder channels. Ensure card-on-file is offered (and consented) at each registration.
- Harden your rails. The Change Healthcare outage exposed single points of failure, which prompted nearly three out of 10 medical groups to update EHR or RCM downtime protocols in 2024. If you haven't, build in redundancy: a secondary clearinghouse connection, direct-to-payer submission for top plans, backup eligibility/ERA feeds, and contingency workflows for patient estimates and statements if a vendor goes down. Test downtime drills enough that staff are prepared for the real thing.
- Protect net collections. Inventory all payment methods and fees. Convert virtual cards to standard EFT where possible; document prohibited fees in payer contracts; train staff to spot unauthorized deductions.
Practices that tightened TOS collection, simplified payment plans, and reengineered work around zero-touch flow generally saw steady to better performance in 2025. Those most affected by cyber disruptions, payer friction, and rising patient cost burdens struggled. The play for 2026 is to collect sooner, touch less, and insulate your cashflow — so unforeseeable macro shocks don’t become patient A/R problems you’re still chasing next fall.
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