Prerequisites
- Payments posted daily, so patient responsibility is current
- A signed financial policy on file
- An online payment channel
- Card-on-file authorization where you use it
Statement cadence
1
Send within days of adjudication, not at month-end
Batching statements to the first of the month means a patient seen on the 3rd gets a bill in the following month, six or more weeks after the visit. By then they have forgotten the encounter and treat the bill as an error. Statement timing moves collection rates more than statement wording.
2
Second statement at ~30 days
With a clearer call to action and the payment link prominent.
3
Contact at ~45–60 days
A call or text. Offer a payment plan. A conversation collects more than a third letter.
4
Final notice at ~75–90 days
Stating plainly what happens next.
5
Decision at ~90–120 days
Collections, write-off, or continued internal follow-up.
Delivery: digital first
Digital delivery with a one-tap payment link materially outperforms paper. Collect mobile numbers and email addresses at registration and get consent for electronic communication.
Keep a paper option for patients who need it, and comply with any state requirements on billing notice format.
Make paying trivial
Every additional step loses payers:- A link that goes directly to the balance, not to a portal login
- No account creation required to pay
- Mobile-optimized, because most people will open it on a phone
- Multiple methods, card, ACH, digital wallet
- Payment plans self-service, with defined terms
- The practice name on the statement and the card descriptor matching what the patient recognizes
Payment plans
Define the terms in advance so staff aren’t negotiating case-by-case:
Autopay with a card on file, under a signed authorization, is what makes plans complete. Plans requiring the patient to remember each month largely don’t.
Financial policy
Have patients sign one at registration. It should cover:- When payment is due
- Accepted methods and card-on-file authorization
- Payment plan availability and terms
- No-show and late-cancellation fees
- What happens to aged balances
- Financial hardship and charity care, if offered
- Self-pay pricing and good faith estimates
Good faith estimates
The No Surprises Act requires a good faith estimate of expected charges for uninsured and self-pay patients who schedule a service or request an estimate.1 This applies whether or not you contract with payers. Cash-pay practices are not exempt. Build the GFE into scheduling, not into billing — it is triggered by scheduling or a request, not by a claim. See The No Surprises Act.Prevent balances rather than chasing them
The highest-leverage work happens before the statement:- Estimate from the 271, not the insurance card. Cards go stale.
- Collect at the point of care. The cheapest dollar you will ever collect.
- Under-collect on uncertainty. Collecting 50 and refunding $20.
- Explain the estimate before service, so the bill isn’t a surprise.
MSO-PC notes
Patient payments are the PC’s revenue and land in the PC’s account, like payer money. See Structure accounts across your entities. Statement operations are an MSO function — the MSO employs the staff and licenses the systems. But financial policy affects the patient relationship and, at the margin, access to care, so the PC should approve it even though the MSO executes it.Verify it worked
- Statements go out within days of adjudication
- Digital delivery with a direct payment link is the default
- No account creation required to pay
- Card descriptor matches the practice brand
- Payment plan terms defined, with autopay
- Financial policy signed at registration
- Good faith estimates issued to self-pay and uninsured patients at scheduling
- Point-of-care collection happening, estimated from the 271
- Patient payments landing in the PC’s account
Common failure modes
Sources
- No Surprises Act, Consolidated Appropriations Act, 2021, Pub. L. 116-260, div. BB, tit. I. CMS, No Surprises Act.