Twenty-nine percent of medical group leaders say patient balance collections got worse in 2025, even though most called them flat or better, according to an MGMA Stat poll of 247 practices. A bigger number sits underneath that finding: practices now collect just 56.0% of copays at the time of service, down from 89.9% before the pandemic, MGMA's own benchmarking data shows. The gap between what a practice is owed and what it collects at the front desk keeps showing up later as statements, calls, and write-offs.

Time-of-service collection has been sliding for years

In its most recent published comparison, cited again in an October 2025 MGMA Stat article, MGMA found that copay collection at the time of service fell from 89.9% in 2019 to 56.0% in 2022, a drop of nearly 34 percentage points. Collection of non-copay patient-due balances at time of service moved the other way over the same years, rising from 14.76% to 39.0%, as more front desks started asking for a share of the deductible up front instead of waiting for a mailed statement. The gap between average and top-performing practices is wide. MGMA found primary care practices in the top tier collect 21.0 percentage points more at time of service than the median practice, nonsurgical specialties collect 36.5 points more, and surgical specialties collect 16.0 points more. That gap represents the same patients and the same balances, collected earlier instead of later.

The deductibles behind those balances keep growing

KFF's 2025 Employer Health Benefits Survey, based on responses from more than 1,800 firms with at least 10 workers, put the average deductible for single coverage at $1,886, up from $1,773 the year before and up 17.0% over five years. Twenty-nine percent of covered workers are now in an HSA-qualified high-deductible plan. At small firms, 53.0% of workers face a deductible of $2,000 or more, and 36.0% face $3,000 or more. Out-of-pocket maximums have grown alongside deductibles: 72.0% of workers with single coverage face a maximum above $3,000, and 21.0% face one above $6,000. Average family premiums reached $26,993 in 2025, a 6.0% increase from 2024, and workers paid $6,850 of that themselves through payroll deductions.

Patients are telling researchers they cannot keep pace

A PayZen survey of 1,001 adults who had a hospital visit or surgery in the past 24 months, published in December 2025, found the average household can set aside only $82 a month for out-of-pocket medical costs, down from $97 a month in the company's 2024 report. Thirty-eight percent of respondents postponed or skipped needed care because of cost in the past year, up from 36.0% in 2024, and 78.0% said inflation had made care less affordable. Among those who delayed care, 52.0% skipped a follow-up appointment and 40.0% went without a prescription. Only 24.0% recalled getting a cost estimate before a visit, and just 16.0% said they were offered a payment plan.

Practices are changing collection habits, slowly

An MGMA Stat poll of 333 practices found 41.0% had updated patient payment plans or options in the year before the May 2024 survey, up from 27.0% of groups that reported a similar change in 2021. Roughly 40.0% of claims now process "zero-touch," without staff review, MGMA reported. Some of the friction sits on the payment side rather than the patient side: 60.0% of practices said they had been charged undisclosed electronic payment processing fees, typically 2.0% to 3.0% per transaction. None of this is happening while costs hold still. Nine in ten medical groups reported higher year-to-date operating costs in 2025, an average increase of 11.0%, and close to 30.0% of groups had to update billing and EHR downtime protocols after the 2024 Change Healthcare outage. An earlier MGMA Stat poll found 56.0% of practices reporting that days in accounts receivable had increased, against 31.0% reporting no change and 14.0% reporting a decrease.

Where practice leaders say the money actually leaks

Asked to name the single biggest leak in the revenue cycle, 48.0% of medical group leaders pointed to denials and appeals in a January 2026 MGMA Stat poll of 288 practices, ahead of front-end registration issues at 23.0%, billing and collections problems at 14.0%, coding errors at 13.0%, and charge posting mistakes at 2.0%. The same poll found 68.0% of groups had added or expanded AI tools in the past year, mostly for ambient documentation and note-taking during visits. Collections work, the second-largest category of named leak once front-end and billing issues are combined, has not seen the same wave of automation.

Time-of-service collection rate20192022
Copay collected at time of service89.9%56.0%
Patient-due balance collected at time of service14.76%39.0%

Source: MGMA benchmarking data, cited in MGMA Stat, October 2025.

Read together, the MGMA and KFF numbers describe two trends moving toward each other. Patients owe a larger share of every visit, and a smaller share of what they owe gets collected before they leave the building. The practices MGMA flagged as top performers have not solved patient affordability. They have simply moved more of the same conversation about money earlier, to the point of service, where it takes less staff time to resolve than a fourth statement and a collections call three months later.

Sources

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