For years, emergency medicine providers have watched the number of self-pay and high-deductible plan (HDHP) patients climb. With mass Medicaid disenrollments due to the unwinding of the pandemic-era continuous enrollment provision and continued employer reliance on higher deductibles, most experts predict patient cost-sharing will grow.
Routine and emergency healthcare expenses add significantly to basic financial struggles for many families. Yet the patient share of healthcare financial responsibility is increasing, even for those lucky enough to have commercial coverage. According to KFF’s 2024 Employer Health Benefits Survey, the average annual deductible for single coverage was $1,787. Of note, the average deductible is considerably higher for workers employed by small firms ($2,575).i
Self-pay and HDHP patients take longer to pay and have a higher risk of write-off. This adds to the already significant financial strain on emergency medicine providers. Poor collection rates stall the cash conversion cycle and contribute to the already low profit margins plaguing most emergency medicine providers.
Emergency Medicine Self-pay Challenges
Compounding the self-pay collection challenges, situations that are common in emergency medicine also cause downstream financial woes. These include:
- Patients who are unconscious or unable to communicate their demographic or insurance information
- Patients with missing, incomplete or incorrectdemographic and insuranceinformation
- Patients lacking knowledge regarding insurance eligibility (e.g., have lost Medicaid coverage or incorrectly believe they are self-pay)
- ED staff who, in a state of urgency, may not obtain demographic and insurance information
All these situations complicate the patient intake process, make it more difficult to submit a clean claim, and prolong the time to collect. To streamline these revenue cycle management (RCM) complexities, emergency medicine billing teams would do well to incorporate automated RCM optimization technology into their workflows to more effectively manage patient-responsible receivables.
A New Approach to Improving Self-pay Collection Rates
One of the most effective solutions for combatting the lack of reliable patient demographic and insurance information is an automated RCM optimization solution suite that can find, correct, and verify patient and payer data.
Key features of the best performing solutions include real-time tools for demographic verification, insurance discovery, deductible monitoring — and importantly, self-pay analysis.
The latter scours multiple databases and pulls in various income and credit indicators to build a reliable financial profile of each patient. These personalized profiles for self-pay accounts empower providers to partner with patients financially, whether by offering compliant, charitable discounting, payment plans, or even helping them obtain retroactive Medicaid coverage.
Look for self-pay analysis technology that provides:
- Insight into each patient’s unique financial characteristics, including available credit
- Federal Poverty Level to assist in determining hardship or charity care eligibility
- Income and credit indicators
- Community-based credit information when standard credit information for patient is not available
Addressing the patient’s individual circumstances to improve their financial experience contributes to improved collection rates for the provider and greater patient satisfaction. The results can be dramatic. Using a leading RCM optimization tool like ZOLL® AR Boost® Self-pay Analyzer can potentially improve a provider’s self-pay collection rate by more than 30%.
At the same time, partnering with patients on financials is a collaborative approach that averts the cost and hassle of sending accounts to collections. Providers improve the likelihood of capturing maximum revenue, and patients avoid the hardship of unexpected and unmanageable medical bills.
Maximize Revenue with Personalized Financial Experiences The bottom line is that using technology to better understand a patient’s eligibility and financial characteristics leads to better cli
i KFF 2024 Employer Health Benefit Survey, https://www.kff.org/health-costs/2024-employer-health-benefits-survey/, KFF Health Affairs, accessed 10/8/25
