Patient balances now represent a larger share of practice revenue than they did a decade ago, and the reason is structural. According to KFF, the average deductible for single coverage has risen 43 percent over the past ten years, and more than a third of covered workers now carry deductibles of $2,000 or more. That shift is why healthcare payment processing solutions have moved from a back-office concern to a revenue one.

That shift moved a substantial portion of collections from insurers, who pay predictably through established EFT channels, to individual patients, who pay on their own schedule and through whatever method the practice makes available. Many practices are still asking those patients to pay the slow way: a paper statement mailed weeks after the visit, followed by phone calls.

The gap between how patients want to pay and how practices ask them to pay is where most billing friction lives. Closing it is largely a matter of infrastructure.

Why Healthcare Billing Is Harder Than It Looks

Retail billing is simple. One party, one amount, one moment of payment. Healthcare billing has none of that.

A single visit can involve a copay collected at check-in, a claim submitted to a primary insurer, potential coordination with a secondary payer, an adjudication process that takes weeks, and a final patient balance that nobody, including the practice, could have stated accurately on the day of service. Then the practice must communicate that balance clearly enough that the patient understands and pays it.

Layered on top is compliance. HIPAA governs how patient information is handled, PCI DSS governs how card data is handled, and the two sets of requirements apply simultaneously to any system touching both.

The administrative cost of getting this wrong is significant. MGMA benchmarking puts the cost of reworking a single denied claim at $25 to $181 depending on complexity, and Experian Health’s 2025 State of Claims survey found 41 percent of providers running denial rates of 10 percent or higher, up from 30 percent in 2022. Every denial is staff time that produces no revenue.

Collect Earlier in the Visit

The most reliable predictor of whether a patient balance gets paid is how early in the encounter the practice asks for it. Patients are engaged and present at check-in. Six weeks later, when a statement arrives, that visit has receded into memory and competes with every other bill in the household.

Health systems that pushed collection efforts earlier in the visit have seen measurable results. A survey of revenue cycle leaders conducted by PayZen and HFMA found health systems collected 31 percent of total patient billings in 2026, up from 24 percent a year earlier.

Practically, this means running eligibility verification before the appointment, presenting a good-faith estimate of patient responsibility at check-in, collecting copays and known balances at the point of service, and offering to keep a payment method on file for the balance after adjudication.

Make Electronic Payment the Default

Patient preference on this question is not ambiguous, and the gap between preference and practice is wide. InstaMed’s Trends in Healthcare Payments research found that 70 percent of consumers receive their medical bills in the mail while only 9 percent want to pay that way, a split that has held steady across several annual editions of the report. The practices closing that gap are the ones getting paid faster.

Practices that close that gap tend to implement a consistent set of capabilities:

• A secure online payment portal accessible without creating an account
• Text and email statement delivery with a direct payment link
• Card-on-file processing with tokenized credentials for post-adjudication balances
• ACH acceptance for larger balances and payment plans
• Contactless and digital wallet acceptance at the front desk

Each option removes a step between the patient’s intent to pay and the payment actually landing. Every removed step improves the collection rate.

Use ACH Where It Fits Best

ACH is underused in healthcare relative to how well it fits the problem. It is meaningfully less expensive than card processing, and its cost advantage widens as balance size grows. Card processing typically costs 1.5 to 3.5 percent of the transaction, so a $1,400 balance carries $21 to $49 in processing fees. ACH generally costs well under a dollar regardless of amount.

ACH also suits payment plans better than cards do. Card credentials expire, get replaced after fraud, and decline. Bank accounts change far less frequently, which means fewer failed installments and less staff time spent chasing updated payment information.

For practices offering payment plans on larger balances, ACH combined with automated recurring billing turns a manual collections process into a scheduled one.

Reconciliation Should Not Be a Manual Exercise

Practices commonly run three disconnected systems: a practice management or EHR platform holding the ledger, a clearinghouse handling claims, and a payment processor moving money. When these do not communicate, someone reconciles by hand every month.

Integrated reporting collapses that work. When payment data posts directly against patient accounts and settlement reports match your deposit records automatically, month-end close becomes a review rather than a reconstruction. Staff time returns to scheduling, intake, and patient care.

Integration also makes problems visible sooner. When payment activity is tracked in one place, a practice manager can see where cash is stalling without waiting for the monthly close.

Compliance Belongs in the Infrastructure

The most sustainable approach to PCI compliance is to handle as little card data as possible. Tokenization replaces card numbers with meaningless substitutes, so the practice can bill a stored card without storing the card. Hosted payment pages keep card entry off practice-controlled systems entirely, reducing the scope of what has to be secured and assessed.

Combined with role-based access controls and audit logging, these tools let a practice meet its obligations without building a security program from scratch. The processor carries the heavier portion of the compliance burden, which is the appropriate place for it to sit.

Where to Start

Most practices see the largest return from three changes, in this order. Verify eligibility before the visit so patient responsibility is known in advance. Add electronic statement delivery with a direct payment link so the fastest path to payment is the default one. Offer card-on-file and ACH payment plans so larger balances become scheduled collections rather than open receivables.

None of these requires replacing your practice management system. Each one shortens the distance between service delivered and payment received.

Healthcare Payment Processing Solutions From ReliaFund

ReliaFund has served healthcare practices since 2001 with payment solutions built around how medical billing actually works. Our platform supports ACH processing, card acceptance with tokenized storage, automated recurring billing for payment plans, secure online payment acceptance, and reporting that reconciles against your existing systems.

We are a U.S.-based company, and when you call, a team member answers and connects you with someone who understands healthcare payments. No long-term contracts, and no one-size-fits-all configuration.

Ready to simplify patient billing? Request a consultation with our payment processing experts to see what a modernized workflow would look like for your practice.