No-pay and slow-pay issues in health care accounting

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Students may choose to pursue an accounting degree online for a number of reasons, from a desire to follow a specific career path to a general affinity for accounting. Both types of students may find themselves in a career focused on health care accounting after graduation, whether as part of a long-term, carefully developed plan or simply to secure that first accounting position and start building a resume. There are some distinctive issues common in accounting in health care, including problems with slow and no payment. Students in the University of Alabama at Birmingham’s Bachelor of Science in Accounting program should recognize what these concerns tied to payment mean for their profession and keep these slow- and no-payment considerations in mind as they choose whether to focus on health care accounting or another specialization in the profession.

An accountant using a laptop computer at his desk.

What are the no-pay and slow-pay problems in health care accounting?

The health care industry is unique in the sense that, while individual tolerances of hospitals and other care providers can vary greatly, payments are not as strictly managed as they are in most other industries. Due to ethical considerations — such as the need to provide care to people in emergency situations regardless of their ability to pay for those services — and other issues, including the opaque and complicated nature of health care payments, there are often situations where a patient may be unable to pay a facility promptly. These problems can be viewed as no pay, where the patient never provides compensation, and slow pay, where a patient has to negotiate a payment plan or waits for a significant period of time before settling their debt.

While these issues have always existed in health care, certain recent developments have exacerbated them and raised their profile. High-deductible health plans, for example, offer less-expensive insurance coverage in theory, but increase the payment burden on patients if a major health care need arises. Long-term increases to health care costs in general have also made it more difficult for patients to quickly and completely address medical debts. For accountants working in health care, understanding how the industry is attempting to mitigate issues with bad debt is important.

How the health care industry and accountants address no- and slow-pay concerns

Recognition of no- and slow-pay issues aren’t a problem in and of themselves in health care. There are a number of strategies and tactics where accountants, and the education they receive at UAB, can plan a major role.

Healthcare IT News points to an upfront approach to discussions and consultations with patients facing high costs that is an increasingly popular strategy among hospitals and other providers. While specialists in patient interactions will engage in the actual conversations, accountants in health care finance jobs will need to handle critical behind-the-scenes work focused on evaluating financial risks and managing debt. They will likely find that courses such as Financial Accounting I and II provide relevant information for making effective decisions in this context.

Changes to systems for managing and collecting payments can also lead to improvements in terms of more patient awareness and improved timelines for compensation. Improving billing error rates and closer tracking of outstanding payments, for example, will require collaboration with staff in the information technology and accounting departments, as well as with employees in charge of patient intake. In this context, accounting knowledge from across the course catalog as well as the information provided by the Information Systems course, which gives students an introduction to how these digitals tools are used in the modern economy, are both valuable.


Accountants can also help make an impact in terms of addressing slow- and no-pay concerns by reviewing collections practices and making determinations about the effectiveness of current workflows. With a mix of practices, from in-house collections to working with third parties, there are a number of potential advantages to discover. Accountants can take the lead on financial assessments while also using skills developed in courses such as Business Communications to consider the impact of different approaches to collections, some very gentle and others heavy handed, on patients.

Taking the first step at the University of Alabama at Birmingham

Entering the world of accounting requires a strong educational background. UAB is proud to offer a curriculum that focuses on the world of accounting while also offering exposure to many business concepts that may prove relevant to accountants, whether in health care or a variety of other fields. Students in the UAB online Bachelor of Science in Accounting program benefit from a fully remote approach to learning that allows for a great deal of flexibility in terms of progression through the program while also providing access to highly regarded faculty. To learn more about earning your accounting degree online, get in touch with an enrollment advisor today.

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UAB Collat School of Business: Bachelor of Science in Accounting

UAB Collat School of Business: Course Descriptions BACC

HealthcareITNews: Providers must be flexible in helping patients afford their healthcare, TransUnion study shows

Forbes: How Healthcare Providers Can Use Technology To Increase Cash Flow, Patient Satisfaction

HealthAffairs: Cash Flow Dynamics And Family Health Care Spending: Evidence From Banking Data