Medical Billing Processes

If patients were a commercial payor, you would've fired your managed care team over this contract years ago. Worst yield. Highest cost to collect. Fastest growing. Any other payor relationship with that profile triggers a board-level escalation. Patient AR? It loses the annual budget fight every time. I spent time with Cedar's team unpacking why the old propensity-to-pay model is basically a credit score cosplaying as a strategy, and what a behavioral model built on 80+ dynamic attributes looks like in practice. The macro backdrop makes this urgent: ACA deductibles up 37% in a year, uninsured population jumping from 1.3M to 5.2M in 2027, and $68.5B coming out of hospital revenue. The next 18 months will separate the health systems that figure out patient financial experience from the ones that don't. Be ready. Read my latest deep dive: https://lnkd.in/gs5Jp9mN (written in collaboration with Cedar but, as always, 100% me)

Over the years, the definition of a strong revenue cycle for patient billing has changed. It used to be about getting the bill out accurately and on time. Today, a strong revenue cycle is defined by patient trust and supporting patients with a clear path to pay. That’s a different challenge than most core systems were designed to solve. As patient responsibility grows, organizations are realizing that sending the same statement, on the same schedule, to every patient produces very different results. Some patients pay immediately. Some need options. Some need reminders. Some need help understanding what they owe in the first place. Ignore those differences and the results diverge quickly, because the experience isn’t designed for how patients actually behave. That’s why most leaders I speak with aren’t asking for a new billing system. They’re asking how to close the gap between a coordinated care experience and a financial journey those systems were never built to support. Increasingly, the ability to meet patients at the right moment, in the right channel, with the right options is essential.  And the good news is that tools like generative AI are powerful enablers of such personalized approaches. That’s the focus behind Cedar Intelligence, our AI and data-driven engine built to support more adaptive patient financial experiences. We complement major EHRs like Epic, athenahealth, Meditech, ModMed, and Cerner — extending their billing capabilities to create a comprehensive patient financial experience. Using data, advanced learning models, and automation, we guide each patient toward a more personalized path to resolution. The result: patients feel more in control, staff spend less time chasing balances, and financial performance becomes far more consistent.

Next up in Elion's definitive guide series: 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗙𝗶𝗻𝗮𝗻𝗰𝗶𝗮𝗹 𝗘𝘅𝗽𝗲𝗿𝗶𝗲𝗻𝗰𝗲 (𝗣𝗙𝗫). For years, PFX was an afterthought. Patient responsibility was small, volume was manageable, and most people simply accepted confusion as part of the process. That's changed with the rise of high-deductible plans. Patient responsibility is now large enough to materially impact revenue. At the same time, new regulations require greater price transparency, and consumer expectations for clear, modern financial workflows have risen across the board. PFX is now a critical priority for many provider orgs. It’s also deceptively hard. The patient financial journey stretches from pre-service through post-service, with numerous handoffs across access, billing, payments, and customer service. Every point introduces complexity, opportunity for error, and the potential to frustrate patients or create avoidable work for staff. Over the past decade (and especially in the last few years with the rise of AI) technology has stepped in to help. Tools now support insurance discovery, real-time eligibility and benefits checks, contract-aware cost estimates, financial assistance orchestration, consolidated statements, digital payments, and AI agents that handle routine billing conversations. Done well, these systems dramatically improve clarity, collections, and satisfaction for patients and staff. But the growing set of tech options brings new challenges: When should organizations deploy best-of-breed point solutions? When is an end-to-end platform the better fit? And how should leaders weigh these options against what their EHR already delivers? Our latest buyer's guide breaks this down. It maps the full workflow, explains where technology actually moves the needle, clarifies the vendor landscape, and offers practical guidance on strategy, sequencing, and ROI. If improving the PFX is on your roadmap for 2026, it's worth checking out. Link is in the comments and we'd love to hear your thoughts.

One of the most common challenges I see in dental practices is front office staff feeling uncomfortable when it comes to collecting payments from patients. This hesitation can lead to missed opportunities for same-day collections, increased accounts receivable, and financial strain on the practice. Why does this happen? 👉 Fear of Conflict: Many team members worry about upsetting patients by discussing money. 👉 Lack of Training: Without clear scripts or guidance, staff may not know how to navigate financial conversations. 👉 Undefined Policies: If payment expectations aren’t clear, the team might feel unsure about enforcing them. 👉 Overwhelmed by Tasks: Front desk teams often juggle so much that payment collection falls through the cracks. 👉 Personal Discomfort: Talking about money can feel awkward if staff aren’t empowered to approach it with confidence. The result? Patients leave without paying, and practices spend unnecessary time and resources chasing down overdue balances. How Can Practices Fix This? ✅ Train Your Team: Equip them with tools, scripts, and confidence to handle payment conversations professionally and empathetically. ✅ Set Clear Expectations: Establish and communicate payment policies upfront, so patients are prepared before their appointment. ✅ Streamline Workflows: Reduce the workload on your front office team and leverage technology to automate parts of the payment process. ✅ Normalize Financial Conversations: Remind your team that discussing payment is just as important as scheduling follow-ups or presenting treatment plans. When front office teams feel supported and confident, they’re more likely to collect payments on the spot—improving cash flow and reducing stress for everyone involved. What strategies has your practice used to empower your team to collect payments at the time of service? Let’s discuss below! 👇

My focus today is on Financial Counseling. This one is for you Practice Operations Leaders out there :) You all know what it is like to purchase a big ticket item like a car or a house. You get a really skilled person assigned to you at the bank (or some connected financial institution) to go through the options on how you will support the purchase. Your credit is checked, your source of income (job, business, other) is verified, some other stuff happens and your options are presented to you. They spend a significant amount of time with you and they follow you through the process ensuring registration/title/deed and/or any necessary insurance is in place; they are usually the folks that hand you the keys. All the way through the process, you can call them, text them or email them for information or to get questions answered. This is their one job, they do it well and they have a process they follow to ensure that all parties (the organization and the customer) are taken care of. It would be silly if none of the pre work was done and the keys are just handed to the customer. Good luck trying to get the payments. In healthcare organizations, the person that "holds the keys" is called the Financial Counselor. FCs are a critically important resource in modern day healthcare. These are the people that are going to guide your patients through their financial healthcare journey and keep your organization and providers safe from harm. They ensure that all financial responsibility is collected from patients, they keep the process moving to provide great customer service; they are the gate keepers for insurance rules and compliant billing practices; they are the go to for the patients for all things financial. These are crucial roles in any organization and extremely important in practices with a heavy self pay population. Because of the behavior of our payors, FCs need to ensure that all information is correctly entered and that patients are adequately informed of any financial responsibility that may arise (no surprises). They need to understand all aspects of services provided in the department and be skilled at collecting, customer service, insurance rules and regulations, and be really, really good at relationship building and maintenance. Highly skilled individuals are needed in these roles. Recruit and hire the best of the best in these roles, pay them well and treat them well. They are driving the success of your Revenue Cycle collections. Remember, the more focus on getting the information correct pre claim submission, the better the chances of getting the claim out the door correctly and on time. Your practice should be paid on the first pass claim submission, minimize rejections, denials or patient dissatisfaction...

In healthcare RCM, Patients are no longer just patients. They’re consumers. They’re in control. This changes everything. → Price tags? Expected. People want to know the cost before they walk in. No more mystery bills. No more sticker shock. → Digital payments? Non-negotiable. Text-to-pay. Mobile wallets. Payment plans. If it’s not easy, it’s not happening. → Clarity? Demanded. Patients want to know what they owe, why, and when. Confusion kills trust. And collections. → Flexibility? Required. High-deductible plans are the new normal. Out-of-pocket costs are sky-high. Patients need options, not ultimatums. → Experience? Make-or-break. A bad billing experience can cost you $400,000 in lifetime revenue. Sixty-four percent will walk after one bad interaction. CMS is watching, too. Patient satisfaction now drives your reimbursements. → Simplicity? Profitable. Three out of four patients don’t understand their bills. Seventy-four percent want digital billing. Make it simple, and you collect more. Loyalty follows. Here’s the new RCM playbook: ☑ Pre-Service: Show your prices. Give real estimates. Build trust before the first appointment. ☑ Point of Service: Offer financial counseling. Give choices. Communicate clearly. No surprises. ☑ Post-Service: Send mobile-friendly bills. Offer payment plans. Make it easy to pay, easy to stay. This is not about chasing payments. It’s about engaging people. Treat patients like consumers, and you win: • More collections • Less bad debt • Higher loyalty • Compliance with value-based care Ignore this shift, and you lose. RCM is no longer about the back office. It’s about the front line. The patient is the new payer. Meet them where they are, or get left behind.

💡Revnue Killers ? Patient Payment Collection Rate – The Silent Driver of RCM Profitability In today’s high-deductible healthcare environment, Patient Payment Collection Rate (PPCR) has become a critical KPI for financial sustainability. 💡 What is it? The percentage of patient-responsible balances successfully collected out of the total amount owed. 🔍 Why it Matters More Than Ever Patient responsibility now contributes 30–40% of total revenue in many US healthcare organizations Rising deductibles = higher risk of bad debt & write-offs Poor collection strategies directly impact cash flow and margins 📊 Key Challenges in Improving PPCR Lack of upfront cost transparency Ineffective patient communication Limited digital payment options Delayed follow-ups on patient balances Fragmented front-end and back-end processes 🚀 Strategies to Improve Patient Payment Collection Rate ✔️ Front-End Financial Clearance Eligibility + benefits verification Accurate patient estimates before service ✔️ Point-of-Service Collections Train staff to confidently collect upfront Offer flexible payment plans ✔️ Digital-First Payment Experience Mobile payments, patient portals, auto-pay options Text/email reminders for dues ✔️ Segmentation & Analytics Identify high-risk accounts early Tailor collection strategies based on patient behavior ✔️ Automation in Follow-ups Intelligent workflows for reminders and escalations Reduce manual dependency and improve consistency 📈 Impact You Can Expect 15–25% improvement in patient collections Reduced bad debt and aging AR Enhanced patient experience and trust 🎯 Leadership Insight Organizations that treat patient collections as a consumer experience problem (not just a billing function) consistently outperform peers. 💬 How is your organization adapting to the shift toward patient-responsible revenue? Let’s exchange insights. #RCM #HealthcareFinance #PatientCollections #RevenueCycleManagement #DigitalHealth #HealthcareLeadership #RCMTransformation

76% of American families have less than $400 in liquid savings. That should stop you cold. Because if most households only keep a few thousand in ready cash- even in wealthy countries - then asking for a lump-sum payment on a multi-thousand-dollar procedure is a non-starter. We live in a monthly payment society. And if you own a vision correction clinic, this is where it hits. Your patients almost never have the cash to pay outright. Financing bridges that gap. It reframes the price from a lump sum into a monthly payment. It matches how people already buy cars, phones, and even furniture. It also signals premium: patients think, “If there’s financing, this must be a serious purchase.” That positions it as an investment, not a quick spend. Installing financing as a means of payment is a no-brainer in 2025. Number one, it’ll likely increase your adoption by +/- 30%. And if you think that no one will take you up on it, then you almost certainly can raise your prices. And when you do, financing will be your friend. If you’re struggling with cash flow, third-party financing is a great solution that will get you paid faster. That accelerates the cash collection cycle. That enables you to spend much more on acquiring patients. That grows your business.

The ongoing dispute between hospitals and insurance companies over pricing is undoubtedly holding back the potential of cashless claim settlements. Despite a slight improvement in the percentage of claims settled through cashless mode (58.39% in FY24 vs. 55.74% in FY23), it’s still far from the desired 90-100% target. The root causes—pricing disagreements, delays in pre-authorization, and a lack of transparent communication—are contributing to prolonged claim processes, frustrating both hospitals and policyholders. The recent launch of the "Cashless Everywhere" initiative offers hope, particularly for higher-value claims where cashless settlements are more common. The upcoming regulatory changes in October 2024, requiring faster approval timelines for cashless requests, should further improve the process and enhance the overall customer experience. However, until cashless settlements become the norm, CarePal Money is stepping in to bridge the gap with Reimbursement Financing. This service addresses the challenges caused by empanelment issues between hospitals and insurers, ensuring smoother healthcare financing for patients and hospitals alike. How does it work? * Underwrites the customer’s health insurance policy * Assesses the likelihood of receiving insurance reimbursement within the next three months * Provides immediate liquidity to patients facing reimbursement delays * Helps hospitals improve cash flow while awaiting insurance payouts With 35% of all health claims in India paid via reimbursements and a financing opportunity of $3 billion annually, reimbursement financing is emerging as a critical solution to ease the financial strain on patients and hospitals. For true progress, insurers and hospitals must foster greater cooperation, streamline communication, and resolve pricing issues. Until then, solutions like Reimbursement Financing will continue to ensure patients receive timely medical care without financial distress. https://lnkd.in/dTWTiMQz

For years, billing lived in the background.   Patients never saw it. Providers barely talked about it. And leadership treated it like an administrative necessity.   That era is over.   Today, the financial journey is part of the care journey.   A patient can have an excellent clinical experience…and still leave a one-star review because of a confusing statement, a surprise balance, or a call that was never returned.   We have to stop separating care from collections.   Think about it:   • If eligibility isn’t verified clearly, trust erodes. • If estimates aren’t transparent, frustration builds. • If statements are confusing, patients feel misled. • If follow-ups feel aggressive instead of supportive, referrals disappear.   In 2026, reputation isn’t shaped only in the operatory. It’s shaped at the front desk. On the phone. Inside the billing statement.   The most forward-thinking practices understand something powerful:   Financial clarity is customer service. Operational discipline is brand protection. And every billing touchpoint is a reflection of your culture.   The practices winning referrals today aren’t just clinically strong. They’re financially transparent, responsive, and organized.   Because patients don’t distinguish between “medical care” and “administration.” To them, it’s all one experience.   If your revenue process creates friction, it doesn’t just slow cash flow. It quietly damages growth. #HealthcareLeadership #PatientExperience #MedicalPracticeManagement #DentalPracticeManagement #RevenueCycleManagement #Revesolv #HealthcareOperations #PatientExperience #HealthcareStrategy #PracticeGrowth #OperationalExcellence #LeadershipInHealthcare