St. Louis-based Ascension has made significant progress in stabilizing its revenue cycle after last year’s ransomware attack — as well as the Change Healthcare cyberattack — created billing delays, payment disruptions and a temporary backlog of claims.
The Catholic health system reported net days in accounts receivable of 51.3 at June 30, 2025, a 27-day improvement from the same time last year. While still slightly elevated compared to the 47-day average prior to the cyberattack, the trend signals a meaningful recovery in the system’s ability to collect payments and manage cash flow, management said in a financial report published Sept. 17
Ascension’s net unrestricted cash and investments totaled $15.5 billion at June 30, 2025, representing 39% of total assets. The system also reported 228 days cash on hand, up 34 days from the end of fiscal 2024. Executives attributed the stronger liquidity primarily to improved AR collections following the disruptions, offset by routine capital spending, debt payments and accounts payable.
The system has also diversified its liquidity resources. Ascension maintains up to $3 billion in short-term liquidity facilities, including a $1 billion syndicated line of credit committed through Nov. 18, 2027, and a $500 million line renewed through Aug. 12, 2026. In fiscal year 2025, which ended June 30, the system also tapped a $1 billion commercial paper program, repaying about $650 million so far.
The 2024 cyberattack temporarily increased AR days as billing, payment posting and claims workflows slowed, according to the health system. To offset the disruption, Ascension received about $1 billion in advance payments from Medicare and select commercial payers. All of those advances were fully recouped by the end of 2024.
Despite those headwinds, Ascension’s collections momentum in FY25 reflects what executives called “meaningful progress” on resolving the backlog of claims.
The 95-hospital system’s ability to improve AR performance while maintaining strong liquidity underscores the importance of resilient revenue cycle operations.
While AR days have not yet returned to pre-incident levels, Ascension’s trajectory points toward continued recovery. For a system of its scale, disciplined AR management and liquidity flexibility will be key to sustaining long-term revenue cycle strength.
