> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Run patient statements and balances

> Statement cadence, digital delivery and text-to-pay, payment plans, financial policies, good faith estimates, and when balances go to collections.

Patient balances are now a large share of practice revenue and the hardest to collect. The controls that move the number are **timing**, **delivery channel**, and **making payment trivially easy**, not the wording of the letter.

## 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

<Steps>
  <Step title="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.**
  </Step>

  <Step title="Second statement at ~30 days">
    With a clearer call to action and the payment link prominent.
  </Step>

  <Step title="Contact at ~45–60 days">
    A call or text. Offer a payment plan. A conversation collects more than a third letter.
  </Step>

  <Step title="Final notice at ~75–90 days">
    Stating plainly what happens next.
  </Step>

  <Step title="Decision at ~90–120 days">
    Collections, write-off, or continued internal follow-up.
  </Step>
</Steps>

## Delivery: digital first

| Channel                     | Cost per statement                      | Response |
| --------------------------- | --------------------------------------- | -------- |
| **Text with payment link**  | Very low                                | Highest  |
| **Email with payment link** | Very low                                | High     |
| Paper                       | Meaningful, including postage and labor | Lowest   |

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

**Descriptor mismatch is the leading cause of healthcare chargebacks**, and it is worse in an MSO-PC structure where the legal entity name differs from the brand by design. Configure the card descriptor to the practice brand the patient saw on the door. See [Prevent chargebacks](/guides/payments/prevent-chargebacks).

## Payment plans

Define the terms in advance so staff aren't negotiating case-by-case:

| Element                    | Typical                                                       |
| -------------------------- | ------------------------------------------------------------- |
| Minimum balance to qualify | $200–$500                                                     |
| Maximum term               | 6–12 months                                                   |
| Minimum monthly payment    | $25–$50                                                       |
| Autopay required?          | Usually yes, it dramatically improves completion              |
| Interest                   | Generally none; charging it raises consumer lending questions |
| Default handling           | Defined in advance                                            |

**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

A signed financial policy is also your best evidence in a chargeback representment.

## 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.<sup>1</sup>

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](/concepts/compliance/no-surprises-act).

## Prevent balances rather than chasing them

The highest-leverage work happens before the statement:

1. **Estimate from the 271, not the insurance card.** Cards go stale.
2. **Collect at the point of care.** The cheapest dollar you will ever collect.
3. **Under-collect on uncertainty.** Collecting $30 when unsure and billing the difference beats collecting $50 and refunding \$20.
4. **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](/guides/banking/structure-accounts-across-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

| Failure                              | Consequence                                    |
| ------------------------------------ | ---------------------------------------------- |
| Month-end statement batching         | Bills arrive six weeks late; treated as errors |
| Paper-only delivery                  | Low response, high cost                        |
| Payment requires portal registration | Large drop-off                                 |
| Descriptor doesn't match the brand   | Chargebacks                                    |
| Payment plans without autopay        | Low completion                                 |
| No GFE for self-pay                  | No Surprises Act non-compliance                |
| Estimating from the card             | Overcollection and refunds                     |

## Sources

1. No Surprises Act, Consolidated Appropriations Act, 2021, Pub. L. 116-260, div. BB, tit. I. CMS, [No Surprises Act](https://www.cms.gov/nosurprises).


## Related topics

- [Set up card payments](/guides/payments/set-up-card-processing.md)
- [Use collections agencies (carefully)](/guides/billing/handle-collections.md)
- [Issue a patient refund](/guides/payments/issue-a-patient-refund.md)
- [Deductibles, copays, coinsurance, and patient balances](/concepts/payments/patient-responsibility.md)
- [Chargebacks: when patients dispute card payments](/concepts/payments/chargebacks.md)
- [The No Surprises Act, briefly](/concepts/compliance/no-surprises-act.md)
- [Card dispute reason codes](/reference/banking/chargeback-reason-codes.md)