[3] RESEARCH · WHITE PAPER 2026.01
SUPERSCRIPT.NYC
A DATA-DRIVEN ANALYSIS · 17 SPECIALTIES · 1.27M CLAIMS · 26 PRACTICES
The State of
Patient Collections.
We analyzed 1.27 million patient-owed claims to understand what's actually happening with collections as practices adopt more tools to capture patient revenue.
6-MONTH COLLECTION RATE · FY 2024–25
0.0%
The data reveals where collection works, where it breaks down, and what drives the difference.
[1] THE HEADLINE
N=1,265,627 · 6-MO WINDOW
Where the uncollected
dollars are.
Deductibles are 22% of uncollected claims but 55% of uncollected dollars. Copays are the opposite: 44% of uncollected claims, 19% of the dollars. The collection problem is concentrated in a small number of high-balance deductible claims, not spread evenly across the book.
CHART 1A
Uncollected by claim volume
EACH SQUARE = 1% OF UNCOLLECTED CLAIMS
CHART 1B
Uncollected by dollars
EACH SQUARE = 1% OF UNCOLLECTED DOLLARS
Deductibles are 22% of uncollected claims but 55% of uncollected dollars.
CHART 2
Collection rates by cost-share type
6-MO RATE · PRACTICE AVG (UNWEIGHTED) VS DOLLAR-WEIGHTED
"By practice" treats each practice equally regardless of size. "By dollars" weights each practice by how much patient liability it carries. The gap between the two reveals that larger practices collect at higher rates, pulling the dollar-weighted number above the simple average. Copay shows the widest gap: 86% by practice, 91% by dollars, revealing that larger practices collect copays at materially higher rates.
CHART 3
Practice-level collection rate distribution
EACH DOT = 1 PRACTICE · IQR 66.6%–85.8%
No single number captures the full picture. The best practice collects 97%; the worst, 34%.
CHART 3B
The spread narrows for copay, widens for coinsurance
EACH DOT = 1 PRACTICE · IQR: COPAY 83–93% · DED 70–88% · COINS 70–86%
CHART 4
Collection rates across 26 practices with wide-ranging department counts
AGGREGATE RATE (DOT) · DEPARTMENT RANGE (BAR) · FY 2024–25
Multi-department practices show wide intrapractice variance. The largest multi-site network (173 depts) ranges 26–100%. Single-department practices show only the aggregate dot. Departments with >$10K liability and ≥25% collection rate included.
| Metric | Value |
|---|
| Claims analyzed (N) | 1,265,627 |
| 6-month collection rate | 75.8% |
| Practice-level range | 30.6% – 97.1% |
| Practice-level median | 77.9% |
| Practice-level IQR (P25–P75) | 66.6% – 85.8% |
| Median collectable per claim | $30 |
| Mean collectable per claim | $69 |
[2] THE 60-DAY WINDOW
N=1,265,627 · LOG TIME AXIS
After day 60,
the curve flattens.
For every dollar a patient owes, the collection curve answers: when? The answer is front-loaded. The average practice has already collected 24% by the time the first bill posts. 62% within 30 days. 69% within 60. From day 61 to day 180, the marginal return is just 7 cents on the dollar. The shape holds across all 26 practices.
CHART 5 · CENTERPIECE
The collection curve
CUMULATIVE % COLLECTED · DAYS FROM FIRST LIABILITY POSTING
Practice-average rates measured from first patient-liability posting date. Denominator is TRANSFERIN (cost-share liability). Each practice weighted equally regardless of size. All active departments, FY 2024–25.
The average practice collects 69 cents in the first 60 days, then only 5 in the next 60, and 4 over the next six months.
CHART 6
Balance size is the strongest predictor of collection speed
CUMULATIVE RATE BY BALANCE BUCKET · 6-MO WINDOW
Under $50: 91% at six months. Over $1,000: 54%. The gap opens early: by day 14, small balances are at 46% while $1,000+ claims have reached only 25%.
[3] BALANCE & COST-SHARE
BALANCE SIZE · COST-SHARE TYPE
What patients owe determines
whether they pay.
Copays collect at 91%. Deductibles at 80%. Coinsurance at 77%. Balance size compounds the effect: the $0–$50 bucket collects at 91%, while $1,000+ claims collect at 54%. Copays are stable up to $100, then drop sharply. The $1,000+ bucket is under 1% of claims but holds the largest single share of uncollected dollars.
CHART 7A
Collection rate drops as balance grows
6-MO AGGREGATE
CHART 7B
Unpaid share quadruples above $1,000
FULLY PAID · PARTIAL · UNPAID
The $1,000+ problem: These claims represent under 1% of volume but concentrate the most uncollected dollars of any bucket. Only 45% are fully paid within six months, and 32% collect nothing at all.
CHART 7C
Dollars collected vs uncollected, by balance
6-MONTH HORIZON · BLUE = COLLECTED · RED = UNCOLLECTED
The $1,000+ bucket is <1% of claim volume but holds the largest single share of uncollected dollars.
CHART 8
Copay collection is stable to $100, then drops
COLLECTION RATE BY COPAY AMOUNT
Copays from $10 to $50 collect above 92%. Above $100, rates dip to 83%. Above $150, they fall to 71%, approaching deductible territory. The $100 mark is the clearest threshold in the data.
The $251–$1,000 zone (68–70% collection) is where payment-plan intervention has the highest return: balances large enough to matter, but not so large that patients have already received financial counseling. Collecting any portion of a balance upfront establishes a payment relationship that changes downstream behavior.
[4] THE DEDUCTIBLE SHIFT
ALL ACTIVE DEPARTMENTS · 2019–2025
Deductible patterns vary more
by specialty than by year.
Across all practices, deductibles hold a steady 42–47% of cost-share liability, but that aggregate hides real movement at the specialty level. Cardiovascular practices saw deductible share grow 6 percentage points since 2019 and OB/GYN grew nearly 5, while dermatology and vascular shifted toward copay. Deductible claims are 5x a copay claim by average balance and collect slower at every time horizon. Every January, reset deductibles spike to 63% of cost-share liability, concentrating dollars in the slowest-collecting category. But those January claims actually collect at the highest rate of the year.
CHART 9
Deductible share of patient liability, 2019–2025
STACKED TOTAL · ALL ACTIVE DEPARTMENTS
CHART 9B
Three specialties, three different stories
COST-SHARE COMPOSITION · 2019–2025
One practice per profile. Gastroenterology: deductible share fell from 63% to 48% as copay grew from 15% to 36%. Dermatology: copay-dominant at 48–53%, nearly flat. Vascular Surgery: coinsurance-dominant, steady at 51–59% across all years.
CHART 9C
Deductible share is shifting in some specialties, not others
DEDUCTIBLE % OF COST-SHARE LIABILITY · SAME-STORE PRACTICES · 2019–20 vs. 2024–25
Same-store comparison: only practices with patient-liability data in both 2019 and 2025. Denominator is copay + deductible + coinsurance (excludes Other/Self-pay). Cardiovascular practices (averaged) saw deductible share grow 6 percentage points; OB/GYN grew nearly 5. Dermatology and vascular moved in the opposite direction, with copay share growing at the expense of deductible. GI and primary care were essentially flat. The aggregate trend masks specialty-level divergence.
CHART 10
Deductibles spike to 63% of cost-share liability every January
COST-SHARE MIX AS % OF MONTHLY TOTAL · JAN 2022 – DEC 2025
January deductible liability is nearly 4x December. Q1 concentrates 36% of annual deductible dollars in 25% of the calendar.
CHART 11
January deductible claims actually collect best
MONTHLY DEDUCTIBLE COLLECTION RATE · 2024
Counter-intuitive: deductible claims in January collect at 84% while December claims collect at 77%. Early-year awareness of the deductible reset may drive faster payment.
[5] YEAR-OVER-YEAR TRENDS
ALL ACTIVE DEPARTMENTS · 2019–2025
Collection rates climbed
14 points, then plateaued.
The aggregate collection rate rose from 65% in 2019 to 78% in 2023, then held near 77% as new practices joined the dataset. Coinsurance saw the largest gain of any cost-share type, surging 45 points from 31% to a 76% peak in 2024. Copay rates held above 90% across all years. Q1 collection rates hold steady despite larger balances, but the composition shift concentrates dollars in the slowest-collecting category.
CHART 12A
Collection rate peaked in 2023, then settled
ALL ACTIVE DEPARTMENTS · 6-MO AGGREGATE RATE
Aggregate rate climbed from 65% (2019) to 78% (2023), then held near 77% as new practices joined the dataset.
CHART 12B
Coinsurance surged 45 points from 2019 to 2024 peak
6-MO RATE BY COST-SHARE TYPE
Coinsurance collection rose from 31% (2019) to 76% (2024 peak), the largest gain of any cost-share type. Copay held above 90% across all years, peaking at 93% in 2023.
| Period | Avg collectable | 6-mo rate |
|---|
| Q1 2024 | $62.99 | 84.3% |
| Q2–Q4 2024 | $57.13 | 78.9% |
| Q1 2025 | $72.55 | 74.1% |
| Q2–Q4 2025 | $87.19 | 56.1%* |
Q1 outperforms Q2–Q4 in both years (84% vs 79% in 2024; 74% vs 56% in 2025). The Q2–Q4 2025 figure is artificially low as late-2025 claims have not reached their full 180-day payment window. The composition shift persists: deductible share jumps from 38% to 58% of cost-share liability in Q1, concentrating dollars in the slowest-collecting category.
[6] PATIENT BEHAVIOR
PAYMENT HISTORY · BALANCE FATIGUE · VISIT PATTERNS
Past behavior predicts
future payment.
Patients who have previously paid all claims collect at 87%. One prior default drops the rate to 59%. The effect compounds: patients with $250+ in cumulative prior unpaid balances collect at just 48% on new claims, a 40-point drop from those with clean histories. The top 1% of patients by unpaid balance own 46% of all uncollected dollars.
CHART 13
Prior unpaid balances collapse future collection
PATIENTS WITH 3+ CLAIMS · COLLECTION RATE BY CUMULATIVE UNPAID BALANCE
Patients with $250+ in cumulative prior unpaid balances collect at 48%, down from 88% for patients with clean histories. Each balance threshold marks a step down: $1-25 (82%), $26-50 (73%), $51-100 (69%), $101-250 (64%). History computed across all claims ever at the practice.
CHART 14
One prior default drops collection from 87% to 59%
COLLECTION RATE BY ALL-TIME PATIENT PAYMENT HISTORY
Patients who have previously paid all claims collect at 87%. One prior unpaid claim drops the rate to 59%; two or more drops it to 54%. History computed across all claims ever at the practice.
CHART 15
1% of patients own 46% of all uncollected dollars
PARETO DISTRIBUTION OF UNCOLLECTED BALANCES · FY 2024–25
The top 1% of patients by uncollected balance (~5,000 patients) account for 46% of all uncollected dollars, averaging ~$1,920 each. Targeted outreach to the top decile addresses 94% of all outstanding patient A/R.
CHART 16A
New patients collect 14 points lower
RATE · NEW VS ESTABLISHED
New patients: 67% vs 81% for established. First-visit patients lack payment history and may not have payment methods on file. New = within 30 days of first-ever visit at the practice.
CHART 16B
Frequent visitors collect highest at 81%
FY 2024–25 INTRA-WINDOW
Patients with 7+ visits collect at 81%, 9 points above single-visit patients at 72%. Repeat patients have established payment methods and smaller per-visit balances.
[7] SPECIALTY & SETTING
17 SPECIALTIES · 26 PRACTICES
Patient collections pose a bigger challenge
for some specialties, and CPTs.
Dermatology collects at 97%. Gastroenterology, the largest specialty by dollar volume, collects at 64%. Within every category, the spread between individual practices dwarfs the group average.
CHART 17
6-month collection rate by specialty
GREEN ≥85% · YELLOW 70–85% · RED <70%
Dermatology leads at 97%. Mental Health (91%) and Family Medicine (87%) also collect above average. Gastroenterology (64%) and OB/GYN (65%) lag. Single-practice specialties (n=1) reflect one practice, not a benchmark.
CHART 18
Gastroenterology: largest collection opportunity by dollar volume
Y: 6-MO RATE · X: MEDIAN BALANCE · SIZE: TOTAL $
Bubble size = total collectable. Gastroenterology combines high claims, low rate, and low price awareness.
CHART 19
Collection rate by procedure code
BAR LENGTH = 6-MO COLLECTION RATE · COLOR = RATE TIER
CHART 20
Established visit complexity doesn't affect collection. New patient complexity does.
E&M OFFICE VISIT COLLECTION RATE BY COMPLEXITY LEVEL · FY 2024–25
Established visits (99212-99215) collect at 87% regardless of complexity. New patient visits drop from 87% at level 2 to 78% at level 5 as average balance rises from $55 to $81. The gap is 9 points at the highest complexity, suggesting new patients are sensitive to balance size in ways established patients are not.
[8] WHERE THE MONEY GOES
87,406 CLAIMS SENT TO COLLECTION
62% of uncollected dollars go to
collection agencies.
When internal follow-up fails, the default path is external collections. Nearly two-thirds of uncollected patient dollars are written off to third-party agencies, which recover an estimated 25–40% of face value. This is the most expensive dollar a practice collects. The 75.8% rate does not include what agencies recover; it measures only what the practice collects internally.
CHART 24
Where write-off dollars go
FY 2024–25 · PATIENT ADJUSTMENT TRANSACTIONS
Of the $13M sent to external collection agencies, industry benchmarks suggest 25–40% of face value is recovered. At the midpoint (32%), that implies ~$4.2M returned to practices through third-party collections. This recovered amount is not captured in the 75.8% rate, which measures only internal collection.
[9] KEY TAKEAWAYS
What the data
says.
[A] FOR PRACTICE OPERATORS
[1]
The first 60 days are everything.
The average practice collects 69% within the first 60 days of billing. Months three through six add just 7 points. Nearly a quarter is collected before the first bill even posts. Deductible and coinsurance claims start around 7% at billing, making immediate outreach on those categories the highest-return operational change.
[2]
Intervene by balance size, not by days outstanding.
$1,000+ balances are under 1% of claims. Only 45% are fully paid versus 89% under $50. Payment-plan offers triggered by balance amount at the time of billing, not after 90 days of non-payment, intercept the problem early.
[3]
Build a January playbook.
Deductibles spike nearly 4x in January. Q1 concentrates over a third of annual deductible dollars in 25% of the calendar. Q1 deductible claims collect at the highest rates of the year (83–84%) when patients expect the charge. Proactive communication before January 1 keeps that advantage.
[4]
Coinsurance is the least collected, least understood cost-share type.
Lowest 6-month collection rate at 77%. A simple "your plan pays X%, you'll owe approximately $Y" message at scheduling closes the price-awareness gap that separates 91% collection from 77%.
[B] FOR INDUSTRY OBSERVERS
[1]
The deductible shift is specialty-dependent.
Aggregate deductible share has held steady at 42–47% since 2019, but the average masks real movement. Cardiovascular and OB/GYN practices saw deductible share grow 5–6 points; dermatology and vascular shifted toward copay. Benefit design is reshaping the collection challenge differently by specialty.
[2]
Collection rates climbed 14 points since 2019 but plateaued.
65% to 78% (2023), then held near 77%. The easy gains from eligibility tools and price transparency may be tapped out.
[3]
24.2% of patient liability remains uncollected at six months.
Across 26 practices. The gap is binary, concentrated in the 10% of claims where patients pay nothing.
[4]
Break the balance-fatigue spiral.
Patients with $250+ in cumulative prior unpaid balances collect at 48% on new claims, down from 88% for those with clean histories. The decline is steep and starts early: even $1-25 in prior balance drops the rate to 82%. Payment plans before balances accumulate prevent the spiral from starting.
[10] METHODOLOGY · LIMITATIONS · DATASET
FOR REPRODUCIBILITY
How to read
this report.
The dataset
26 specialty practices on Athena EHR across 16 states. 1,265,627 claims with patient liability in FY 2024–25. The dataset grew 7x since 2019 as practices onboarded. Aggregate metrics use the FY 2024–25 cross-section; year-over-year trends use all active departments.
CLAIMS WITH PATIENT LIABILITY
1.27M
FY 2024–25
6-MO COLLECTION RATE
75.8%
ALL PATIENT LIABILITY
APPENDIX A
Claims analyzed by year, 2019–2025
PATIENT-LIABLE CLAIMS PER CALENDAR YEAR
Self-pay & uninsured claims
Parts 1 through 8 measure collection on insured patient cost-share: copays, deductibles, and coinsurance assigned by insurance through the TRANSFERIN transaction. Self-pay claims, where the patient owes the full charge with no insurance cost-share assignment, are excluded from those analyses. The two populations differ in balance size (3.5x higher for self-pay), collection workflow (no EOB-driven posting timeline), and patient expectation (no payer-negotiated rate). Combining them would obscure both stories.
Self-pay represents 4.3% of claims but 14.0% of patient liability in FY 2024–25. Self-pay identification uses the absence of a TRANSFERIN (cost-share assignment) transaction, which may capture patients whose insurance was expected but never posted, not just true uninsured patients. This makes the self-pay population noisier than the insured cohort. What follows is a standalone profile.
APPENDIX E
Self-pay: 4% of claims, 14% of liability
SELF-PAY LIABILITY ($M) · % LABELS = SHARE OF TOTAL
APPENDIX F
Self-pay collection lags insured and is more volatile
6-MO COLLECTION RATE BY YEAR
| FY 2024–25 | Insured | Self-pay |
|---|
| Claims | 1,211,092 (95.7%) | 54,535 (4.3%) |
| Patient liability | $75.2M (86.0%) | $12.2M (14.0%) |
| 6-month collection rate | 77.9% | 62.9% |
| Average balance | $62 | $224 |
| Median balance | $28 | $94 |
| Sent to collections | 78,518 · $9.8M | 5,286 · $2.2M |
| Other write-offs | 23,592 · $2.2M | 9,919 · $1.8M |
| Write-off exposure | 16.0% of liability | 32.2% of liability |
Self-pay collection peaked at 80% in 2019, when the dataset comprised 10 practices. The rate dropped to 59% in 2022 as larger practices with more complex self-pay populations joined. Nearly a third of self-pay dollars are written off, twice the insured rate. The two lines crossed in 2022: before that, self-pay actually collected better than insured cost-share, likely because the earlier, smaller practices had more straightforward self-pay populations (elective, price-known). *2025 is a partial year with payment-window truncation.
Methodology
Collection rate calculation. Per-claim collectable = TRANSFERIN + CHARGE + TRANSFEROUT + ADJUSTMENT (excluding COLLECT and OTHER adjustment reasons), floored at zero. Per-claim collected = patient PAYMENT (negated), capped at collectable. Collection rate = sum of collected / sum of collectable across all claims in the population. This methodology is applied consistently across every chart in this report.
Time windows. Primary analyses use a 180-day window from claim service date, measured by payment post date. The collection-curve analysis measures cumulative payments at day 0, 3d, 7d, 14d, 30d, 60d, 90d, 120d, and 180d. "Day of service" uses payment postdate ≤ claimservicedate to capture point-of-service collection.
Why exclude COLLECT/OTHER adjustments. COLLECT and OTHER are negative adjustment categories that typically represent write-offs to external collection agencies or administrative write-offs. Including them in the collectable formula would shrink the denominator and inflate collection rates. Excluding them keeps written-off balances in the denominator, meaning the rate reflects what was actually collected from patients relative to total patient liability.
Aggregate vs practice-level rates. Aggregate collection rates are dollar-weighted: total collected divided by total collectable across all claims. When practice-level variation is reported, each practice's rate is calculated independently. The collection curve uses practice-average methodology: each practice's rate at each time window is calculated independently, then averaged across all 26 practices, weighting each practice equally regardless of size. Sample sizes are flagged throughout (N=).
Same-store comparisons. Year-over-year cost-share composition (Chart 9B) uses a same-store cohort: only practices with patient-liability data in both 2019 and 2025. This controls for the effect of new practice onboarding, which would otherwise distort share trends. The denominator for cost-share composition is copay + deductible + coinsurance TRANSFERIN dollars only (excluding Other/Self-pay), so shares sum to 100% across the three categories. Where two practices share a specialty, their shares are averaged.
Limitations
- Single-EHR platform. All data is sourced from Athena. Practices on other systems may exhibit different transaction patterns or collection workflows.
- Selection bias. The 26 practices elected to work with a patient collections platform; they may differ from non-participating practices in operational maturity.
- Small N for subgroup analyses. Many specialty categories (N=1–2 practices); directional only.
- No patient demographics. All analyses use de-identified patient claims data. Age, income, insurance tier, and geographic density are unavailable.
- Plan type coverage gap. Plan type is available for only ~19% of claims via the claims_with_srt join. Sample, not census.
- Cost-share allocation. Patient payments are not tagged by cost-share type. Cost-share-specific rates classify claims by dominant TRANSFERIN reason; payments are attributed to the claim, not the specific cost-share category.
Source tables
| Table | Schema | Purpose |
|---|
transaction | prod_core.base_athena | Charges, payments, transfers, adjustments |
claim | prod_core.base_athena | Service date, patient, department |
department | prod_raw.raw_athena | Department specialty (one multi-specialty practice) |
provider | prod_core.base_athena | Specialty, taxonomy, type |
claims_with_srt | prod_edw.entities | Procedure code, plan type, payer |
Key filters: voideddate IS NULL on all transaction queries. transactiontransfertype = 'Patient' isolates the patient financial responsibility bucket. Adjustment transactions with reason COLLECT or OTHER are excluded from the collectable formula to avoid deflating the denominator with write-offs.