Patient Balances Become Larger Revenue Focus for Health Systems, Survey Finds

Patient collections are becoming a more significant part of health systems’ revenues, increasing attention on the difficulties organizations face in obtaining timely payments for care, according to a new survey report from healthcare fintech vendor PayZen and the Healthcare Financial Management Association.

The survey, based on responses from 205 healthcare revenue leaders, found a growing emphasis on patient balances. Twenty-two percent of respondents identified patient balances as their single highest priority, roughly double the 11% recorded a year earlier. PayZen described patient balances as a “nearly universal” concern among respondents, with concern levels rising from 73% in the prior survey.

Commercial revenue remained the leading priority overall, though the percentage of respondents selecting it declined from 75% last year to 62% in the latest survey. Government program revenue also increased slightly, with 16% identifying it as their top concern compared to 13% previously.

According to PayZen, the shift reflects increased premiums, high-deductible insurance plans, and stricter Medicaid eligibility requirements, which are placing a larger share of healthcare costs on patients. Survey responses showed that patient billings represented 12% of health systems’ total net patient revenue, though organizations reported collecting an average of 31% of those balances.

“When patients were secondary payers, the financial conversation could wait until after care was delivered,” Itzik Cohen, chief executive officer of PayZen, wrote in the report’s foreword.

Cohen also wrote that patients are increasingly becoming the payer and that health systems across the country are developing approaches to address that change.

PayZen noted that the 2026 survey included greater representation from larger health systems with annual revenues of $200 million or more. Because of this, the organization said year-over-year comparisons should be viewed as directional indicators rather than exact measures of change.

When asked about priorities related specifically to patient balances, just under half of respondents said increasing new collections was their primary focus. Forty-one percent said improving the patient financial experience was a key priority, while the same percentage cited reducing bad debt. Another 36% identified reducing days in accounts receivable as a leading concern.

The report also highlighted differences between larger and smaller organizations. Health systems with more than $5 billion in annual revenue were more likely than organizations with less than $1 billion in revenue to identify reducing bad debt and improving patient financial experience as top priorities. Smaller organizations were more likely to prioritize reducing days in accounts receivable.

The survey also identified gaps in financing offerings and awareness of payment plan defaults. Eight percent of respondents said their organizations do not provide in-house payment plans to patients. That figure rose to more than 16% among health systems with less than $1 billion in revenue. Nearly three in five respondents said their payment plans are capped at 24 months, which PayZen said “virtually guarantees higher default rates” because patients have limited ability to dedicate monthly funds toward healthcare costs.

Seventy-two percent of revenue leaders said their organizations do not know their average default rates for in-house payment plans. Those that tracked defaults reported an average rate of just over 13%. PayZen said its own evaluations found a 20% default rate and stated that organizations may be underestimating their internal risk by more than 50%.

The survey also found increased use of third-party patient financing, rising from 38% in the previous survey to 44% in the latest poll. Among adopters, 36% identified cash acceleration as their top priority. Pre-service payment policies increased from 81% in 2025 to 92% in 2026, while average pre-service collection rates rose from 16% to 21%.

Generative artificial intelligence is also being used in revenue cycle operations, with 37% of respondents reporting adoption and 85% of the remaining respondents expressing interest. Larger systems reported higher adoption levels, with denials management and appeals representing the most common use cases at 45%.

PayZen’s findings were echoed by data from Kodiak Solutions, which reported that insured patients were responsible for 7.3% of their medical bills in 2025, up from 6.8% in 2024. Kodiak also said insured patient yield declined from 45.1% in 2024 to 42.4% in 2025.

Healthcare organizations across the country are facing increasing financial pressure as patient payment responsibilities continue to grow. A recent survey reveals that Health Systems are now placing greater focus on collecting patient balances to stabilize revenue streams and reduce financial risk. Rising deductibles, changing insurance models, and increasing treatment costs are pushing Health Systems to rethink their revenue cycle management strategies.

Why Patient Balances Are Increasing

Many Health Systems are experiencing a significant rise in unpaid patient balances due to high-deductible insurance plans and out-of-pocket healthcare expenses. Patients are now responsible for a larger share of medical bills, making collections more challenging for providers.

The survey found that Health Systems are investing in digital billing systems, automated payment reminders, and financial transparency tools to improve collection rates. These efforts help patients better understand their financial obligations before treatment begins.