Patient POS collections pose a growing problem for RCM departments

Hospitals are collecting more of the amount owed by patients at the point of service (POS), but that effort is failing to put a dent in the overall collection rates by hospitals, according to a new report from Kodiak Solutions.

The report notes that healthcare providers are getting better at collecting from patients, but the remaining balances are getting more difficult to collect.

POS collections as a percentage of patient payments totaled 30.1% in the first quarter of 2026, a dip from a year earlier when the total was 30.6%. Meanwhile, POS collection rates climbed to 24.8% of patient payments from 22.7% a year earlier.

The improved POS collections are driven by efforts to improve communication with patients.

“Our biggest recommendation coming out of these reports is ensuring that we are investing in the patient financial experience, and there’s not a great AI tool to do that,” said Matt Szaflarski, vice president, revenue cycle, for Kodiak, in an interview.  Providers need to develop relationships with patients and have conversations with them on what they can expect.

In the report, the recommendations are:

• Embed payment plans earlier in the patient journey. Rather than waiting until after discharge, organizations can introduce structured payment plans while the patient is still in house or at the point of service, when engagement is highest and expectations are being set. This helps convert larger patient responsibility balances into committed, manageable payments before they age.
• Make POS conversations about affordability, not just collection. Framing POS interactions around options, for example, partial payment plus enrollment in a payment plan can increase capture without creating friction. This is especially important when today’s higher deductibles make full POS collection less realistic for many patients.
• Strengthen the transition from POS to self-pay after insurance through prearranged payment commitments. When a balance isn’t resolved at POS, having a payment plan already established reduces reliance on reactive self-pay after insurance outreach and improves early-stage, self-pay yield.
• Leverage third-party solutions to stabilize patient responsibility cash flow. Some organizations are using vendors that effectively assume patient responsibility up front and then manage repayment directly with the patient. This can reduce internal workload, accelerate cash collection and insulate providers from variability in patient payment behavior.
• Use benchmarks to identify where payment plan adoption is lagging. Benchmarking can highlight gaps in POS capture rates, payment plan utilization and early self-pay performance by service line or patient segment. This helps leaders focus on the behaviors and workflows behind revenue leakage.

It is going to get  worse

Szaflarski said the problem of collecting from patients is only going to get more difficult because of OBBBA, which is effectively driving large numbers of people out of Medicaid. People who are no longer covered by Medicaid are going to have to pay for a high-deductible exchange plan or go without insurance.

“So, we’re going to have even more patient responsibility flood the market starting next year,” he said. “Right now is the time to exercise that (communication) muscle, for lack of a better term, and develop a strong patient financial experience strategy,” Szaflarski said.

The report also found large differences in POS cash collections as a percentage of patient payments, based on payer type.