Healthcare providers collect just 31 cents of every patient dollar: PayZen

NEW YORK, UNITED STATES — United States health systems are collecting just 31 cents of every dollar billed to patients — a 69-cent gap that a new PayZen survey of 205 revenue cycle leaders says most health systems are only now beginning to address.

Patient billing gap costs health systems

The finding comes from PayZen‘s State of Healthcare Affordability: Provider Perspective 2026 report, conducted in partnership with the Healthcare Financial Management Association (HFMA).

Patient billing accounts for just 12% of a health system’s total net patient revenue — a small slice of overall revenue, but one where collections consistently fall short.

Interest in developing a stronger patient finance strategy more than doubled in one year: from 19% of health systems in the 2025 survey to 41% in 2026.

“If you make it hard or confusing for a patient…then you get paid less. You’re leaving money on the table,” said Tobias Mezger, co-founder and chief revenue officer of PayZen.

The survey found that despite the 31-cent collections rate, adoption of patient finance solutions has been slower than the revenue opportunity would suggest.

Vendors and AI drive collections turnaround

Mezger attributed the slow adoption to past experience with vendor-driven products that prioritized financial engineering over patient outcomes — a credibility gap the sector is still working through.

“[Providers] have been burned before. Frankly, a lot of the vendors…were more about financial engineering rather than getting the patient the right solution,” Mezger said.

More than one in three health systems now use AI in the revenue cycle — a shift that is beginning to change how patient billing and pre-service financial engagement are approached.

The PayZen report identifies early financial engagement — reaching patients before service rather than after — as a key performance driver for closing the collections gap.

The healthcare outsourcing sector — a multibillion-dollar industry covering revenue cycle management, patient billing, medical coding, claims processing, and pre-service financial counseling — is directly positioned to address the shortfall health systems are now naming as a strategic priority.

Outsourced RCM operations scale the patient financial engagement workflows — early outreach, payment plan structuring, eligibility screening — that in-house teams at most health systems lack the bandwidth to run at full volume.

With providers collecting just 31 cents on the dollar, the gap compounds at scale — and the health systems that close it fastest will hold a structural revenue advantage their peers will not.