January through March can feel like a financial pressure test for many providers. It’s when patient-pay balances surge, deductibles reset, and the cracks in intake, billing, and payment follow-up get exposed.
But here’s the truth: Those cracks usually begin months earlier, and with a good process, you can prevent a Q1 backlog before it ever starts.
Here’s how to prepare now so you’re not scrambling come deductible season.
Why Deductible Season Hits DMEs Especially Hard
Deductible health plans have become more common over time.
Higher deductibles often push more financial responsibility onto patients, increasing patient-pay balances for DME providers. Because of this, patients with high deductibles often wait until after the reset to schedule equipment or services.
At the same time, recent studies show that overall patient collection rates have declined. One industry report noted a collection rate drop of over 3%.
These trends make preparing now essential. Don’t let next month be a scramble—proactive providers treat deductible season like a predictable cycle and manage it.
Start With Your Patient Autopay Process
Autopay is a frontline defense during deductible season. When a patient’s deductible resets, the speed and reliability with which you collect can make or break your revenue flow.
Keith Kuhn says, “First, you need the technology to support autopay. But the other half is having the rapport with patients—and the processes and referral relationships—to confidently take payment information up front.”
Here’s what to prioritize now:
- A system that securely stores payment information and supports recurring billing (like TrueSight).
- The ability to detect expiring or invalid cards.
- Staff trained to ask for card-on-file information in a way that feels professional and routine.
- Coordination with referral partners to make payment expectations clear early.
Enrolling a patient in autopay at intake begins the process, but many providers stop there. Without ongoing maintenance (card updates, follow-ups, etc.), the advantage of autopay quickly erodes.
Keith puts it like this: “Getting a card on file is just the start. The real breakdown happens when cards expire or decline, and no one follows up. All the front-end effort falls apart if that part of the process isn’t maintained.”
Requesting Card-on-File Information is All About Rapport and Clarity
Autopay tech only works if patients are comfortable sharing payment information; intake and referral staff play a key role in creating that comfort. The goal is to make the request part of the standard process, like asking for insurance or prescription history.
To do that, train your team to use straightforward language that normalizes auto-pay. For example: “We’ll take a card on file now so we can manage patient balances smoothly and avoid delays in billing later.”
Reinforce that having a card on file doesn’t guarantee immediate charges, but enables swift billing once services are delivered.
When communicated clearly and early, many patients appreciate the convenience. But the real benefit is that you get to lock in payment readiness before insurance resets.
The Critical Back-End: Track Card Fall-Off and Follow Up
This is where many providers lose ground, even those with solid intake processes. When credit cards expire, are declined, or become invalid, the lack of follow-up results in a significant drop in revenue (especially painful during deductible season).
Common pitfalls to avoid:
- Expired or declined cards aren’t flagged or cleaned up.
- No one has ownership over card maintenance or follow-up.
- Patient balances age when your staff get busy elsewhere.
- Collections lag, turning patient-pay balances into bad debt or backlog by Q1.
Keith emphasizes the timing, saying, “The pain isn’t as bad in January. But come February, and March, the impact can be significant if your processes aren’t tight.”
“You have to track your fall-off—how many cards are expiring or failing—and what percentage of new setups are enrolled in auto-pay. That’s how you keep patient-pay collections high.”
“This exact breakdown is one of the reasons we built the TrueSight platform the way we did. Deductible season isn’t a surprise, but most teams are trying to manage expiring cards, failed payments, and follow-up manually or with disconnected systems. TrueSight was designed to surface card fall-off, flag failed payments, and give teams visibility into patient-pay performance before balances snowball into Q1 backlogs. Technology alone doesn’t fix the problem, but it gives teams the clarity and structure they need to stay ahead of it….especially when those KPIs are visible inside TrueSight in real time and not just after month-end”
Use KPIs Now to Spot Trouble Before It’s Too Late
Waiting until January to see if your collections wobble is too late. Instead, track key performance indicators (KPIs) throughout the year, so you can identify and correct problems early.
Essential metrics to monitor:
- Percentage of new setups enrolled in auto-pay
- Auto-pay “fall-off” rate
- Average days to follow up on failed payment
- Patient-pay collection percentage (monthly)
- Outstanding patient-pay balances aged over 30, 60, and 90 days
If autopay enrollment is high but collection percentages are slipping, that’s your signal to intervene.
Your Deductible Season Checklist
Completing these tasks before year-end sets you up for smoother patient-pay flow and fewer headaches once deductible season is active.
- Ensure auto-pay software is in place and secure
- Train intake/referral staff with simple, consistent scripts
- Implement a system to flag expired/declined cards
- Assign ownership for payment follow-up (e.g., a billing coordinator)
- Track key KPIs monthly
- Review patient-pay backlog quarterly
“If your processes are consistent and your follow-up is solid, January through March just becomes business as usual,” Keith says.
Need help preparing for 2026? Let’s partner up.
Or, read more industry updates: JC Council Updates: CMS FHIR, CGS Connect, & More