Patient Responsibility Is Becoming a Bigger Part of Practice Revenue. Is Your Billing Process Ready?

For years, healthcare revenue cycle management was primarily about getting paid by insurance companies. Patient balances were a smaller part of the equation, often a copay at the front desk or a relatively modest bill after insurance.

That has changed.

Higher deductibles, coinsurance, and out-of-pocket maximums have shifted more healthcare costs directly to patients. The patient is no longer an afterthought in the revenue cycle. Increasingly, the patient is responsible for a significant portion of the bill. This creates a very different collections challenge.

Patients are responsible for more

In 2025, the average annual deductible for workers with employer-sponsored coverage reached $1,886, according to the Kaiser Family Foundation. At smaller companies, that number jumped to $2,631. At the same time, most covered workers also face a 20% to 30% coinsurance rate for medical services.

As a result, patient responsibility has grown substantially over the past decade, now accounting for roughly 30% of total provider revenue. Managing patient collections effectively is no longer optional. It is a critical driver of a practice's financial performance.

Billing workflows haven’t kept up

The typical patient billing process in place today was built for a different era. A statement gets printed and mailed, and the patient receives it days later. If it goes unpaid, another paper statement goes out the following month, and the cycle repeats until someone eventually makes a phone call or moves the balance into collections. Adding a QR code or payment link can make the final transaction digital, but it doesn’t fix the underlying workflow. Across the industry, practices consistently report collection rates stalling in the 50–60% range after three to four months of mailing statements, even when digital payment options are available.

As patient balances grow and the cost of labor and mailing continues to increase, this approach becomes increasingly inefficient and expensive. Larger balances are harder to collect, and the longer a balance remains outstanding, the less likely it is to ever be paid. Repeated statement cycles eat further into margins, while manual follow-up consumes staff time that could be spent on patient care and other higher-value work.

Part of the problem is that these workflows treat an unpaid balance as if the patient simply needs another reminder. But an unpaid balance does not always mean a patient is unwilling to pay. Patients may be confused about what they owe or whether insurance has paid its share. They may put off dealing with a bill if paying requires creating an account, calling the office during business hours, or mailing a check. Others may need a payment plan but feel uncomfortable asking for one. When the billing process does little to address those barriers, another statement the following month often does little to change the outcome.

Patient collections need a modern workflow

With patient responsibility becoming a bigger part of revenue, practices and billing companies need infrastructure designed specifically to manage it. That means going beyond simply offering a QR code on a paper statement and online bill pay. A modern patient billing workflow should make it easy to:

• Deliver bills digitally, where patients are most likely to see them

• Follow up automatically instead of waiting another 30 days

• Clearly show what is owed and make supporting information easy to access

• Let patients pay securely from a phone without unnecessary logins or friction

• Support cards, HSA/FSA funds, mobile wallets, and installment plans

• Give patients an easy way to ask billing questions in the moment

• Track engagement and prioritize accounts that actually need attention

• Reconcile and post payments without creating another manual workflow

The objective isn’t simply to send more reminders. It is to remove the friction that prevents a bill from getting resolved quickly.

Adapting to the new reality

The shift toward greater patient responsibility isn’t a temporary billing trend. It is a fundamental change in how practices get paid, with a growing impact on revenue, cash flow, and profitability. Practices and billing companies can no longer treat patient collections as an afterthought to the insurance process. They need workflows designed specifically for the realities of patient payments today.

Those that adapt will do more than make it easier for patients to pay. They will collect faster, reduce the administrative work required to manage patient balances, and build a more efficient approach to one of the fastest-growing parts of practice revenue.