Articles

Enhancing Self-Pay AR: Effective Strategies and Tools to Maximize Recovery Rates and Reduce Delinquencies

Jul 15, 2025

With the rise of high-deductible health plans, a growing portion of provider revenue now comes directly from patients rather than insurance companies. That’s why managing self-pay accounts receivable (AR) in the revenue cycle is so important. With the right tools, technology, and workflows, healthcare organizations can: 

  • Decrease operational costs. Efficient self-pay AR management reduces administrative costs associated with billing, follow-up, and collections. 
  • Enhance regulatory compliance. With the right self-pay AR management strategy centered on transparency and next-level patient engagement, hospitals and health systems reduce financial and reputational risks. 
  • Enrich the patient financial experience. With effective self-pay AR management comes clearer communication about healthcare costs, flexible payment options, and transparent billing that improves patient satisfaction, reduces frustration, and fosters a better overall patient financial experience.  
  • Improve cash flow. Effective self-pay AR management mitigates delayed or unpaid bills which makes it easier to fund operations and invest in patient care. 

This article provides revenue cycle strategies and tools to optimize self-pay AR recovery and improve overall revenue cycle management.  

 

Understanding the Self-Pay AR Challenge 

Hospitals and health systems recognize that more of their net patient revenue comes directly from patients than ever before. However, challenges collecting self-pay balances remain. In fact, insured patient collections decreased by 8.3% in 2024 compared with 2023. There are several reasons why self-pay AR continues to be problematic: 

 

  • Higher patient balances. High-deductible health plans increasingly attribute greater fiscal responsibility directly to patients. And as more patients have these types of plans, self-pay AR becomes more difficult to manage. Almost half (47%) of medical groups say they continue to see an increase in self-pay or uninsured patients in their payer mix. 
  • Inflexible payment terms. Rigid payment structures don’t accommodate patients’ financial situations and can lead to nonpayment and disengagement. Without an effective process to navigate evolving financial assistance programs and a streamlined way to connect patients with financial resources, organizations run the risk of nonpayment. 
  • Outdated technology. Many hospitals do not provide patients with a modern, digital payment experience, causing a disconnect and worsening the problem.  
  • Unaffordable healthcare costs. As healthcare costs continue to skyrocket, less than half of Americans budget $50 or more per month for healthcare expenses. When healthcare bills arrive, they simply aren’t prepared to pay them. Recent data suggests that self-pay-after-insurance accounts are the leading source of bad debt, accounting for 57.6% of patient bad debt. 
  • Potential effects of the “One Big Beautiful Bill”. The passage of the “One Big Beautiful Bill Act” on July 4, 2025, has introduced significant changes to Medicaid and the Affordable Care Act (ACA), which are expected to have profound implications for healthcare providers, particularly in managing self-pay accounts receivable. Specifically, the expected reduction in Medicaid coverage is likely to lead to several challenges for healthcare providers such as increased self-pay balances, strain on the revenue cycle, and overall financial instability. 

Effective Strategies to Maximize Self-Pay AR Recovery 

Fortunately, best practice revenue cycle strategies to maximize self-pay AR recovery can help hospitals improve financial performance while simultaneously enhancing patient engagement and satisfaction. Consider the following: 

 

1.  Emphasize transparent communication before the patient’s care journey begins.  

Tools/strategies that can help: Employ an omnichannel, digital first patient communication strategy that includes cost estimators, proactive pre-appointment outreach, financial counseling, and up-front collections. The goal is to achieve patient engagement right from the start and throughout the financial process. 

 

2.  Follow up with patients in a timely manner.  

Tools/strategies that can help: Use automated payment reminders, AI virtual agent chat bots to answer payment-related questions, and empathic outbound calls to connect with patients long before accounts become delinquent. Remember: Consistency, empathy, and trust are the keys to patient engagement.  

 

3. Make it easy for patients to pay.  

Tools/strategies that can help: Promote online payment portals with digital wallets and alternative payment methods, pay-by-phone IVR options, personalized payment plans that make payments more manageable, financial assistance programs, self-service kiosks, virtual waiting rooms where patients can pre-pay using their mobile device, and other online payment solutions that cater to diverse patient needs. 

 

4. Improve front-end revenue cycle processes.  

Tools/strategies that can help: Embrace real-time insurance verification and eligibility as well as screening for Medicaid and other coverage options to prevent back-end rework. 

 

5. Use data wisely.  

Tools/strategies that can help: Leverage propensity to pay models and presumptive charity/federal poverty level calculations to offer the best payment option based on each patient’s ability to pay. 

 

6. Consider third-party collection agencies. 

Tools/strategies that can help: Integrate services to improve recovery rates for aging self-pay AR balances when other efforts are unsuccessful. 

Measuring Success 

Organizations drive continuous improvement of self-pay patient AR by monitoring these essential revenue cycle key performance indicators: 

 

  • Bad debt ratio—percentage of self-pay AR that turns into bad debt. 
  • Collection rate—the percentage of self-pay AR balances collected. 
  • Days in AR—how quickly self-pay AR balances are collected. 
  • Payment plan success—percentage of patients who complete their payment plan successfully. 

A combination of effective revenue cycle strategies and the right technology/tools can maximize self-pay AR recovery and reduce delinquencies. Adopting a patient-centered approach while leveraging technology and data analytics helps hospitals achieve high levels of patient engagement and optimal results. Focusing on self-pay AR recovery enables organizations to improve financial health and patient satisfaction. Contact Revenue Enterprises for a customized solution to optimize self-pay AR recovery and improve revenue cycle performance.

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Karie Bostwick

VP of People and Compliance

As VP of People and Compliance at Revenue Enterprises, Karie Bostwick oversees People functions including recruiting, training, onboarding, engagement and satisfaction. Additionally, she is responsible for compliance training, oversight and monitoring.

Karie has a long history of working in the revenue cycle support industry. Her skills span leadership, operations start up, policies and procedures development, operations workflow, budgeting and client management.

She is passionate about the experience of our people, patients and the Healthcare clients we serve and believes that a team of diverse, talented and motivated individuals working together toward a common goal can make a difference.

Robert Sterett

VP of Information Technology

As a transformational leader Robert Sterett has leveraged his 20 years of experience to build effective service lines and exceptional teams. In his role as VP of Information Technology at Revenue Enterprises, Robert excels at taking a unique, balanced, and strategic approach to technology leadership with people first for the best possible outcome. Using his experience from engineering, project management and service line management he takes a multi-faceted approach to ensure the right people are in the correct position coupled with the best technology to meet or exceed all expectations from security to compliance and business continuity.

Robert’s leadership style lends itself to building long term relationships and has consistently been a relied upon strength in many organizations. Over Robert’s time as an IT operational and project leader, he has spent significant time in both hands-on technology facing roles and client centric management roles to bring the best solutions that strive to meet the business and client needs.

Focusing heavily on his personal development skills and opportunities, Robert continues to foster coaching and mentorship relationships everywhere in his life, and the lives around him.

Douglas Dunbar

VP of Sales & Marketing

As VP of Sales and Marketing for Revenue Enterprises, Douglas Dunbar leads with a passion for building strategic partnerships, nurturing relationships, and upholding customer service excellence. In his role, Doug focuses on marketing and brand strategy, sales team leadership, and working closely with members of the management team to best serve company goals.

Doug has over 28 years of National sales and marketing call/contact center leadership, with 10 years of service specifically at Revenue Enterprises. Currently, Doug serves as part of Wyoming HFMA Chapter leadership and has held various roles in Colorado HFMA Chapter leadership for over 9 years.

In his spare time, Doug is very family oriented. Additionally, he loves traveling, cycling, golfing, fishing, hunting, and boating.

Kris Brumley, MBA

President & COO

As President & COO of Revenue Enterprises, Kris Brumley is a collaborative partner within the executive team and a leader for operational functions across the organization. Kris productively shares vision, drives innovation, and supports those around her in a way that elevates them and fosters continuous improvement and results. She has helped create a supportive environment for clients resulting in 98% client retention and a 65% NPS score for all clients and 75% for top clients by revenue.

Kris possesses an MBA in data analytics and has twenty-five years of experience in the healthcare industry, with 19 specifically in revenue cycle. She brings a wealth of customer service experience to her role and has worn many hats at Revenue Enterprises including Director of Business Development, EBO Division Director, and VP of Client Experience Management.

In her personal life, Kris is as busy outside of work as inside. She values spending time with her family, and enjoys fishing, hiking, traveling and interior decorating and design.

Timothy (Tim) Brainerd

CEO

As CEO of Revenue Enterprises for almost 20 years, Tim Brainerd leads by example. He promotes a shared vision and stewards a culture of Integrity, Passion, and Respect. He has assembled and empowered high-performing talent and teams to support customers, facilitate strategic planning and manage the capital of the company. Under his leadership, Revenue Enterprises has doubled in size three times over the past fifteen years while maintaining a culture of caring and gratefulness.

Tim has close to four decades of revenue cycle experience, including nineteen years with RSI
Enterprises. He has been a past president of Colorado Chapter of the HFMA and a presenting speaker on the topic of Leadership. He is a fifteen-year member of Vistage International, the world’s largest CEO coaching and peer advisory organization for small and midsize business leaders.

Raised in the Midwest, Tim values humble principles like being respectful, caring, passionate, self-reliant, and most importantly grateful. His most important lesson and the lesson he hopes to pass on in all relationships is living the Golden Rule–do unto others as you would have them do unto you. He is intentional in his choices and believes in making decisions, taking action, being accountable, and loving your neighbors.

Whenever possible, Tim spends his time with his wife of nearly forty years, his adult children, and his grandchildren. His hobbies include fishing, golfing, traveling as well as game nights and sharing great food with his family.