The all-in-one healthcare stack is the easiest yes in the building. One vendor, one integration, one contract, one number to call when something breaks. Every procurement team and every engineering lead has felt the pull, because on the day you sign, the bundle genuinely is simpler. The problem is that the bundle quietly assumes your needs will never change. They always do. And the day you want to swap, upgrade, or add one piece, you find out the thing you bought for convenience was actually priced as dependency.

I want to make the case for the opposite approach. Not because bundles are evil, but because the math on them is asymmetric in a way most teams do not price in until it is too late.

The pitch everyone says yes to

Let me steelman the bundle first, because the appeal is real.

If you run a health system, outsourcing an entire function to one vendor means less to staff, one accountable partner, and a single integration to maintain instead of a dozen. If you build a platform, buying a bundled module is faster and cheaper than building it yourself, and it lets you ship a capability you could not have shipped alone. Procurement is simpler. Security review is simpler. The demo is clean. Nobody ever got fired for choosing the suite that does everything.

These are rational reasons. Anyone who tells you the bundle is a dumb choice has not run an understaffed operation or shipped under a deadline. The bundle solves a real problem on day one.

The assumption hiding in the contract

Here is what the bundle assumes: that the org you are today is the org you will be for the life of the contract.

You will not be. Your payer mix shifts. You add a service line. You go through an acquisition or get acquired. A capability that did not exist when you signed, like same-day funding on submitted claims, becomes available and your competitors start using it. Or you decide that a function you once happily outsourced is now core enough to bring in-house. Every one of those is a normal, healthy thing for a growing organization to do. The bundle was built for the company you were, not the one you are becoming.

Static pricing for a non-static business is the whole trap, and it is invisible at signing.

What “swapping one piece” actually costs

This is the part that gets underestimated. In a bundle, the cost of changing one component is buried in three places: the contract, the integration, and your data.

The contract ties the pieces together, so you cannot renegotiate one without reopening all of them. The integration was built once, by them, on their terms, so unwinding it is a project you did not budget for. And your data lives in their formats, which is the quiet killer. As researchers put it plainly, vendor lock-in is the situation where moving to a different vendor is not possible without substantial cost, legal constraint, or technical incompatibility. In healthcare that is sharper than in most industries, because the data is regulated, the formats are proprietary, and a migration that loses or corrupts records is not an inconvenience, it is a compliance and patient-safety event.

For a platform, the consequence is even more direct: if you do not own the layer that matters, you cannot differentiate on it. You have rented your own roadmap.

Convenience now, dependency later

The lock-in is not an accident. It is the business model. The discount you get for buying everything together is not really a discount, it is a fee you pay later in lost optionality, and you do not feel it until the day you want out.

The clearest illustration the industry has is the Change Healthcare outage in early 2024. One vendor sat underneath an enormous share of the country’s healthcare transactions, processing close to 44% of all funds and roughly 14 billion transactions a year. When that single vendor went down, the dependency stopped being abstract. Hospitals stopped receiving payments. Providers could not verify whether patients had coverage. Pharmacies could not process prescriptions. A problem at one company became a problem for the entire system, because so much of the system had been routed through one place.

You do not have to imagine a cyberattack to feel the same dynamic at smaller scale. Any time a single vendor sits between you and your money, their roadmap, their outage, their price increase, and their priorities become yours. Concentration is convenient right up until it is the thing putting you at risk.

The composable alternative

The alternative is not “build everything yourself.” It is composability: modular layers that interoperate by design, where you own your data, keep your workflow, and can add or replace any single component without touching the rest.

Optionality becomes a first principle instead of an afterthought. For a builder, that means you own your roadmap and you can differentiate on the layer that matters to you while buying the layers that do not. For a buyer, it means you keep your leverage, because the day a component stops earning its place, you can replace it without a forklift. The stack becomes a set of interchangeable parts rather than a monolith you are married to.

This is the real argument for treating financial functions in healthcare as infrastructure: layers that plug in and out, not a single suite that owns the whole flow.

Where this bites in healthcare finance

Revenue cycle, clearinghouse, funding, and analytics increasingly get sold as one bundle. That is exactly the wrong shape for the problem, because the cost of slow reimbursement is the kind of thing you should be able to fix by adding a layer, not by re-platforming your entire operation.

That is the bet we made when we built Thrivory. It is a layer, not a suite. It adds same-day funding of 80% of expected claim value, it sits alongside the systems you already run, and it requires no change to how your team bills. Nothing to rip out, nothing to marry into. If it ever stops earning its place, you can remove it as cleanly as you added it. That is the point. Infrastructure should earn its keep every quarter, not hold you hostage to the decision you made years ago.

A checklist before you sign or build

Whether you are buying a bundle or building on one, ask these before you commit:

• What does it cost to leave, in dollars, in time, and in engineering work?

• Do I own my data, and can I export it cleanly and completely?

• Can I swap or add one component without renegotiating or re-integrating everything else?

• Can I adopt a new capability without this vendor’s permission or roadmap?

• If you are a platform: does this let me differentiate, or does it quietly commoditize me?

If you do not like the answers, you are not buying convenience. You are buying dependency, and the bill comes later.

This one is personal for me. I got some of my practical hours to become a registered dietitian at a rural hospital in Fayette, Alabama, about an hour outside of Tuscaloosa. A census of 13 was considered a busy day. Thirteen patients. The entire hospital. If something was serious, patients were sent to Tuscaloosa. If it was really serious, they were looking at a 90-minute drive from Fayette to Birmingham. That was just how it worked. And for the people in that community, that hospital was everything: emergency care, a few swing beds, the nursing home attached to it, the few provider offices nearby that existed because the hospital did.

Experiences like that are a big part of why I ended up getting my MPH. My focus was on nutrition and health outcomes in underserved communities, and the pattern is always the same: when people lose access to essential services, whether it’s a grocery store or a hospital, the health impacts compound. Food deserts get a lot of attention, and they should. But healthcare deserts are just as devastating, and they’re getting worse.

That’s why I’ve been watching the Rural Health Transformation Program so closely. Not just because of Thrivory’s work with health systems, but because I’ve seen what it looks like when a facility is running so thin that the conversation stops being about how to improve care and becomes about how to keep the doors open.

$50 billion is coming. It’s not designed to keep hospitals running.

The CMS Rural Health Transformation Program is the largest federal investment in rural healthcare in American history: $50 billion allocated across all 50 states, with the first $10 billion set to flow starting in October. The goal is to address workforce shortages, modernize infrastructure, expand access, and stand up new care models.

But here’s what’s actually happening on the ground. NPR reported that at least 10 states are using their transformation funding to “right-size” rural hospitals, which in practice means cutting inpatient services. Montana’s plan explicitly says hospitals may need to downsize to qualify for funding. CMS has been clear that the program’s purpose is “not to pay operating expenses.”

Big Sandy Medical Center in Montana, a 25-bed rural hospital that’s been serving its community since 1965, needs $1 million in deferred maintenance, including a failing HVAC system, and can barely make payroll each month. But the transformation fund won’t cover that. For a hospital that’s already down to one emergency room with a single curtain between two beds, it’s hard to imagine what right-sizing even looks like.

The same bill that funds transformation is cutting Medicaid

Becker’s reported that rural health system IT leaders are delaying technology upgrades specifically because of reimbursement uncertainty. Marshall Medical Center in California, a 65-year-old hospital, is putting all infrastructure updates on hold indefinitely.

Here’s where it gets really frustrating. The same legislation that created the $50 billion transformation fund also cut Medicaid by an estimated $911 billion over the next decade, with roughly $137 billion of that hitting rural areas directly. So on one hand, here’s money to transform. On the other, your Medicaid reimbursement is about to get cut, so you’re freezing spending because you don’t know what your revenue will look like in 18 months.

The transformation fund is supposed to drive investment. The Medicaid cuts are causing hospitals to pull back. These two forces are working against each other, and the hospitals caught in the middle are the ones communities depend on most.

When hospitals close, communities don’t just lose a building

According to the Center for Healthcare Quality and Payment Reform, 756 rural hospitals are currently at risk of closure in the U.S. 323 of those are at immediate risk, meaning their financial reserves can only cover losses for two to three years. And according to the UNC Sheps Center for Health Services Research, 146 rural hospitals closed between 2010 and 2023.

What a lot of people don’t realize is that rural hospitals are usually the largest employers in their region. When a rural hospital closes, it’s not just the loss of healthcare. It’s the loss of jobs across every skill level. It’s the loss of employer-based health insurance for families. It’s the loss of income that circulates through local businesses, restaurants, schools. Research shows that hospital closures decreased local labor force participation by 1.4% and led to measurable population decline. When the hospital goes, the community starts shrinking.

And it goes further than economics. A study published in Health Services Research that examined every rural hospital closure in the U.S. from 2005 to 2019 found that in moderately rural counties, closures led to a 10% increase in low birth weight births and later initiation of prenatal care. In the most rural counties, residents were 29-52% less likely to deliver in their own county after a closure.

I think about the women I worked with during my training. If the hospital in a town like Fayette closed, you’re not driving 10 minutes for a prenatal visit. You’re driving 45 minutes to an hour to Tuscaloosa, and if something goes wrong during delivery, you might be looking at another hour-plus to Birmingham for a higher level of care. That’s not a hypothetical. That’s the reality for hundreds of rural communities right now,

I did my WIC rotation in Hale and Sumter County, Alabama. Those are Black Belt counties where access to care was already limited when I was there. Earlier this year, a Public Citizen report flagged Hill Hospital of Sumter County and Hale County Hospital as being at heightened risk of closing or reducing services due to the Medicaid cuts in the same legislation that created the transformation fund.

This is a cash flow problem, and it needs financial infrastructure to fix it

Every transformation plan, in every state, requires working capital. Workforce recruitment costs money. Telehealth build-outs cost money. Chronic care management programs, facility maintenance, equipment upgrades. All of it requires upfront investment. And the revenue from those new services will follow the same reimbursement cycle as everything else: deliver care today, get paid later.

For rural hospitals with heavy Medicaid and Medicare payer mixes, reimbursement takes 60-90 days on a good day. And for many of these hospitals, commercial payers are doing most of the financial heavy lifting. Medicare reimburses roughly at cost. Medicaid often reimburses below cost. The commercial volume is what offsets those losses and keeps operations going. When those commercial reimbursements are also taking 30-60 days to arrive, the one revenue stream that’s actually keeping the hospital afloat is sitting in A/R.

You can’t recruit nurses and physicians when you’re managing cash week to week. You can’t build out the telehealth programs these transformation plans call for when your finance team is spending all their time chasing claims. You can’t even maintain the building you already have when every dollar is spoken for before it arrives.

Here’s what I keep coming back to. Healthcare has infrastructure for submitting claims. It doesn’t have infrastructure for getting paid. Providers submit claims and then they wait. Nobody can tell them with any certainty what they’re going to get paid, when, or whether the claim will even be approved. For a rural hospital running on margins this thin, that uncertainty is the problem.

Cash flow is the prerequisite for transformation. Not something you figure out after the plan is in place. It has to come first. And solving it requires building a financial layer underneath healthcare that gives hospitals predictability: knowing what a claim is worth before it’s adjudicated, accessing earned revenue without waiting months, and not absorbing the risk of every denial.

The bottom line

$50 billion is historic. But the hospitals that need it most are stuck in a cycle: they need to invest to qualify for transformation funding, but they can’t invest because their revenue is trapped in a reimbursement system that was never built for organizations running on margins this thin.

That’s solvable. And it starts with giving rural hospitals the financial infrastructure they’ve never had.

If your hospital or health system is navigating this, we’d love to learn more about your situation.

Thrivory is a healthcare fintech and AI company building the financial infrastructure layer for healthcare. Our platform turns submitted claims into same-day capital with predictive visibility into reimbursement timing and denial risk. Learn more at thrivory.com.

You delivered care. You submitted the claim. And now you wait.

30 days. 60 days. Sometimes longer. If you run a practice, you already know this. You’ve been living it. But I think it’s worth breaking down WHY it takes so long, because once you see how many layers of delay are stacked on top of each other, it starts to make sense why optimizing your billing process only gets you so far.

The claim doesn’t go straight to a check

When your team submits a claim, it doesn’t just land on someone’s desk at Aetna. It goes through your PM system, gets scrubbed by a clearinghouse for errors, and then gets forwarded to the payer. Even if everything is coded perfectly, that’s 1 to 3 days before the insurance company even sees it.

Then they start adjudication. Eligibility verification, coverage confirmation, medical necessity review, coordination of benefits, contracted rate application. For clean claims with zero issues, most states require payers to pay within 30 to 45 days. That’s the best case scenario. And when does the best case actually happen?

The second anything triggers a request for additional documentation or a pre-auth review, the clock resets. If the claim gets denied, you’re looking at another 30 to 60 days just for the first appeal response. And if that appeal gets denied? Start over.

Denials make everything worse

Denial rates keep climbing. Some specialties like radiology and cardiology are seeing rates above 15%, and even across the board, initial denial rates hit 11.8% in 2024, up from 10.2% a few years prior. Missing prior auth, coding errors, timely filing, medical necessity disputes. You know the list.

Every denial creates a whole new cycle of work. Find the root cause, pull the documentation, submit the appeal, wait. A lot of practices don’t have a dedicated team to work denials, so those claims just get written off. That revenue you earned disappears.

Government payers are their own thing

Medicare is actually not terrible on clean electronic claims. Usually 14 to 30 days. But the second there’s a hiccup, you’re in a longer review cycle. Medicaid is a different story entirely and it varies wildly by state. Some state programs take 60 to 90 days. Then throw in government shutdowns, sequestration, and policy changes and it gets even less predictable.

If your practice has a heavy Medicare or Medicaid payer mix (rural hospitals, FQHCs, community health centers, behavioral health providers), this isn’t something you can optimize your way out of. It’s just how the system works.

Nobody talks about the internal lag

There’s also a gap between when care happens and when the claim even gets submitted. Plenty of practices batch claims weekly. Some specialties need documentation finalized before they can bill. Organizations that bill at the end of the month might not submit a claim for three to four weeks after the patient was seen.

So the payer’s 30 to 45 day clock doesn’t even start until the claim is in the system. Add it up and you’re looking at 60, 75, 90+ days from the date of service to actual payment.

What this looks like in real numbers

A practice billing $500K a month with 60 days in AR has $1 million sitting out there that they can’t touch. That’s $1 million that can’t go toward payroll, equipment, hiring, patient programs, or growth. So you take on a line of credit, or you push back purchases, or you just run lean and hope nothing unexpected comes up.

Most practices are doing some version of this right now.

So what can you actually do?

The traditional options aren’t great. You either wait it out, or you take on debt.

There’s a newer approach. Claim advance platforms let you access up to 80% of your expected claim value the same day you submit. When the payer reimburses, the advance gets collected plus a flat fee, and the remaining balance goes to you. If a claim is denied, the platform absorbs the loss. No changes to your billing workflow.

That’s what we built at Thrivory. If you’re curious what this would look like for your specific practice, you can get started here.

Backed by Redesign Health and Trinity Capital, Thrivory also introduces its ThriveNow API that enables instant, risk-free claim settlement embedded in EHR and practice management workflows

NEW YORK, NY – November . 18, 2025 – Thrivory, the first-of-its-kind healthcare AI company that helps providers eliminate reimbursement delays through instant, non-recourse claims settlement, today announced $3.5 million in equity and up to $25 million in credit funding. The raise was led by Redesign Health, alongside an accordion credit facility anchored by Trinity Capital, providing additional capacity as Thrivory scales. The company also unveiled its ThriveNow API, which embeds same-day claim payments directly into electronic health record (EHR) and practice management systems (PMS). This integration enables providers to “Get Paid Today” without incurring debt, requiring personal guarantees, or disrupting existing workflows.

“Providers should not be forced to wait months to be paid for care they’ve already delivered. It’s an unsustainable and outdated business model,” said Devon Seitz, Founder and CEO of Thrivory. “We built Thrivory so that every provider, from independent practices to specialty networks, can finally run their business with the same speed and certainty as the rest of the economy.”

Founded in 2023, Thrivory was engineered to solve one of healthcare’s biggest financial barriers – slow and unpredictable reimbursement – with providers often waiting months to receive payment from insurers. This cash-flow bottleneck forces practices to carry heavy accounts receivable balances, constraining growth, limiting investment in staff and medications, and fueling burnout. At the same time, rising denial rates and payment variance are eroding provider confidence in reimbursement.

Thrivory solves this problem by combining healthcare-specific AI underwriting with real-time payments. The platform predicts claim outcomes with 96% accuracy, flags denials before they occur and advances up to 80% of expected value within hours. If a claim is denied, Thrivory absorbs the loss, ensuring providers never face clawbacks or collections. Providers gain transparency into when claims will be paid, how much they will be reimbursed, and how to improve capture rates.

The ThriveNow API also represents the next stage of innovation, introducing a claims-native financial layer that integrates seamlessly into EHRs and revenue cycle workflows. Providers and platform partners can activate same-day settlement at the point of submission, with automated reconciliation against explanation of benefits (EOB) and electronic funds transfer (EFT) at payout. For providers, it means instant liquidity to fund medications, payroll and growth. For EHRs and PMS platforms, it drives deeper customer stickiness, new recurring revenue and analytics-driven insights.

“Thrivory is solving a problem that has long undermined provider financial stability by accelerating payments in a way that’s risk-free, reliable and deeply integrated,” said Neil Patel, Redesign Health Head of Ventures. “We backed Thrivory because their leadership team has already delivered: they’ve built strong partnerships, demonstrated predictive accuracy above 95% and shown clear traction in the market. The momentum is undeniable, and we believe same-day claim settlement will become the new baseline for how providers are paid.”

Thrivory is already live with multiple customers across states and specialties, achieving zero losses and zero write-offs to date. Customers report growth acceleration of up to 200% after embedding instant payments into revenue cycle workflows. With a net promoter score of 100 and five-star reviews across the board, early adoption underscores the platform’s impact and usability.

“We are proud to partner with Thrivory and provide this credit facility supporting the company’s growth,” said Steven Lambe, Managing Director of Asset Based Lending at Trinity Capital. “Their working capital solution enhances financial flexibility for medical organizations of all sizes, enabling physicians to better invest in their practices and the communities they serve. Thrivory is executing this mission in a smart, safe, and scalable way and we are excited to see what the team accomplishes in the near term.”

The U.S. healthcare system processes billions of claims each year, with tens of billions of dollars tied up in accounts receivable at any given time. Cash-flow strain is particularly acute in high-cost specialties like infusion, behavioral health, diagnostics and imaging, where delays in reimbursement directly limit access to care. At the same time, industry-wide denial rates have climbed to approximately 20% in recent years, leaving providers with increased administrative burden and unpredictable cash flows. Thrivory’s approach not only relieves these pressures but also aligns with an industry-wide push toward real-time payments.

With the new funding, Thrivory will invest in scaling the ThriveNow API, strengthening its risk models and analytics, and expanding underwriting and treasury operations to increase non-recourse capacity and monitoring.

About Thrivory

Thrivory is a healthcare-fintech and AI company that turns medical claims into instant, non-recourse payments through an embeddable API. The platform predicts reimbursement outcomes with unmatched accuracy, flags denials before they happen and reconciles automatically against remittance and funds movement. With the ThriveNow API, providers gain seamless “Get Paid Today” capabilities embedded into their EHR and practice management workflows. Backed by Redesign Health and Trinity Capital, Thrivory is building a claims-native financial ecosystem that eliminates reimbursement delays and empowers providers to manage cash with confidence. Thrivory’s mission is to make instant claim settlement the standard for healthcare payments, freeing providers to grow without the drag of AR risk. For additional information, reach out to info@thrivory.com or fill out a contact request form.

About Trinity Capital Inc.
Trinity Capital Inc. (Nasdaq: TRIN) is an international alternative asset manager that seeks to deliver consistent returns for investors through access to private credit markets. Trinity Capital sources and structures investments in well-capitalized growth-oriented companies across five distinct lending verticals: Sponsor Finance, Equipment Finance, Tech Lending, Asset Based Lending, and Life Sciences. As a long-term, trusted partner for innovative companies seeking tailored debt solutions, Trinity Capital has deployed more than $4.7 billion across over 420 investments since inception in 2008 (As of June 30, 2025). Headquartered in Phoenix, Arizona, Trinity Capital’s dedicated team is strategically located across the United States and Europe. For more information on Trinity Capital, please visit trinitycapital.com and stay connected to the latest activity via LinkedIn and X (@trincapital).

About Redesign Health

Redesign Health is a global venture builder that empowers founders to launch and scale transformative healthcare companies. We help founders overcome the unique challenges of healthcare innovation with an ecosystem and suite of capabilities supporting ideation and diligence, commercial traction, and execution. Since 2018, we have supported founders in launching more than 60 companies that have touched the lives of over 15 million patients. Learn more at www.redesignhealth.com.

For a growing practice, 60 days is not just a delay. It is working capital that is locked up. It is rent. It is payroll. It is a nurse you cannot hire yet. It is an infusion chair your practice needs but cannot get. The care is done. The revenue is earned. The payment is late.

Why this hurts more right now

Costs have not gone down. Staffing is still tight. Payers keep changing rules and prior auth requirements, which affects how fast a claim can move through the system. Multiple 2025 reports are pointing to the same pattern. Claims eventually pay, but they pay slowly, and every extra week sits on the practice’s balance sheet instead of in the bank. 

That is why even well run practices can feel cash pressure in a single month when volume goes up or when a big block of claims is sitting with a slower payer.

Where is the cash getting stuck

Most practices are not failing to bill. The problem shows up after submission.

We speak to practices every day that are doing the work. Claims go out on time. They follow payer rules. The EHR is set up the way payers want it. Then the money crawls in. It is the same story over and over.

• One commercial payer pays in about two weeks.

• Another takes 45 days.

• Medicaid takes longer than anyone wants to admit.

• A few denials hit, staff resubmits, and suddenly payroll for that month is off.

What makes it so frustrating is that the work is already done. The patient was treated. The claim was submitted. That revenue belongs to the practice. It is just sitting in someone else’s queue.

This is a very personal topic for us. Most of our team come from previous healthcare careers. Three people on our team worked together at a leading telehealth network that handled more than a million visits. Telehealth grew fast, but reimbursement did not move at the same speed. Visit volume was there. Patients were seen. Claims went out… But cash still lagged because payers were not paying as quickly as the clinical side was delivering care. Living through that at scale is some of the reasons we build Thrivory. We see the same pattern providers are dealing with today. Modern care, with a payment model 20 years behind.

So when we say this is not an abstract RCM topic, we mean it. We have watched administrators chase remits. We have watched founders track cash daily while waiting for money they already earned. We have seen teams lose hours on resubmissions and appeals instead of working on the things that make the practice more efficient. It wears people out. It is not bad management. It is a payment system that moves too slowly.

The usual fixes are just duct tape

Most practices already do the obvious things.

• Cleaner claims

• Better eligibility checks

• Staff training on denial codes

• Tighter edits in the practice management system

All of that is smart and should continue. It still does not change the fact that payers pay on their timeline. You can improve your rejection rate and still sit 45 to 60 days waiting to get paid. The 2025 surveys are showing that the delay continues to be on the payer side, not the practice.

Traditional financing is not a solution either. Lenders don’t understand healthcare. They want collateral and account control, with full recourse and sky-high fees. A client mentioned during a call that one of the lenders she spoke with wanted a $5k non-refundable due diligence fee. That is a tough pill to swallow when your real problem is that Blue Cross is at day 47.

A cleaner way to think about it

Here is the simple version. You submit a clean, recent claim. You know you will be paid. You just do not know when. That lag is your money trapped in the payer pipeline.

Thrivory was built to unlock that part of the process.

• The practice submits a new claim.

• Thrivory advances up to 80% of the expected value right away.

• When the payer reimburses, Thrivory collects repayment plus a one time low flat fee.

• If the payer does not pay, Thrivory absorbs 100% of the loss.

There is no loan. There is no interest. There are no personal guarantees. Billing and bank setup stay the same. Thrivory is purchasing the claim asset and turning it into immediate capital so the practice can use its own revenue on time. Which is what providers wanted in the first place.

Welcome to instant adjudication.

Let's Talk

TL;DR: CMS has paused Medicare payments for 10 business days during the government shutdown. That delay, stacked on top of the standard 14-day payment floor, pushes many practices’ reimbursement timelines closer to a month. Expect slower cash flow and more rework once Congress resolves the standoff. Now’s the time to tighten your revenue cycle and plan ahead.

The federal government shutdown is now in its third week, and it doesn’t look like we’ll have a quick fix on the table anytime soon.   CMS told MACs (Medicare Administrative Contractors) to temporarily hold the processing of Medicare fee-for-service claims for up to 10 business days. They say the goal is to avoid reprocessing a flood of claims when Congress finally acts. Meanwhile, providers should keep submitting claims as usual, but expect those payments to arrive late. Because Medicare already has a 14-day payment floor, officials say the impact will be minimal. Minimal? Sure. Add a 10 business-day hold on top of that, and the two-week payment window is now looking more like a month, and that’s before a single denial or appeal. That’s not panicking. That’s arithmetic. Medicaid funding continues (for now), so most state payments should keep moving. That does not mean zero friction. Enrollment actions, outreach, and assorted “nice to haves” all slow down during a shutdown, which adds even more sand to the gears. 

What to Expect Next

• Longer Medicare cash conversion cycles. The extra 10-day hold stacks on top of the 14-day floor, so receipts slide to the right even if submissions keep flowing.

• Higher rework risk when Congress resolves the shutdown. MACs often reprocess once extenders are restored, which means more adjustments even after the dust settles.

• Uneven payer behavior. Medicare fee-for-service follows CMS. Medicare Advantage and commercial plans may not mirror it, so expect variability across lines. 

How to get in front of it

1) Model your cash flow with new lags

Add 10 to 15 business days to your baseline Medicare receipts until the hold lifts. If you have daily deposit data, shift the Medicare series right by two weeks and see how that will impact your operating cash and payroll windows.
  

2) Accelerate clean claims

Scrub hard and submit daily, rather than in weekly batches. Fewer edits now mean less pain later if reprocessing occurs.
  

3) Segment your receivables

Tag claims by payer and service date. Track which lines sit under the hold, which pay normally, and which might be reprocessed later. Tell your biller to keep a spreadsheet for aging, dollar-weighted days, and denial trends.
  

4) Watch your MAC closely

Subscribe to your MAC’s portal alerts and email updates. CMS guidance is flowing through MACs first, including when the hold lifts.
  

5) Shore up near-term liquidity

Stop noncritical spending, pace inventory, and hold on to big purchases until Medicare cash normalizes. Keep vendors informed so terms can hold.
  

6) Tighten downstream collections

Work aggressively on secondary and patient balances. Aim for same-week follow-up on EOBs to reduce slippage, as Medicare dollars will be slower.
  

7) Clarify telehealth and coverage details

If you deliver telehealth, verify current coverage and any shutdown-related operational notes from CMS or your MAC to ensure accurate scheduling.
 

Bottom Line

Medicare dollars will still move, but an extra 10-business-day hold and later reprocessing are very real things to keep an eye on. Do the grunt work now. Clean claims. Tight tracking. Clear cash views.

Future-you may be glad present-you acted like a skeptic today. 

If you need help bridging the gap

Thrivory can advance Medicare and Medicaid claims for medical and behavioral health services at a flat fee for the next 90 days. No time-locked contracts, no loans. Try it on a subset of claims and scale as needed.

Let's Talk

Starting October 1, many physicians will get paid less for the same work, automatically. Cigna will roll out a new reimbursement policy that auto-downcodes many level 4 and 5 E/M visits. With the new “Evaluation and Management Coding Accuracy” policy (R49), the policy allows Cigna to reduce claims by one level if the information on the claim does not support the complexity you billed. If you want the original payment, you must appeal after the fact and send the whole chart. That’s the rule as written, folks.

Cigna’s press page adds the usual friendly pitch: almost 99% of in-network providers “won’t be affected,” and adjustments will “only” drop a single level, and you can ask for a bypass after you send enough records… unggghh… They even published a fax number like it’s 2003. This hits your most common high-complexity visits, level 4 and 5 office visits and consults (99204-99205, 99214-99215, 99244-99245). Evernorth Behavioral Health claims are excluded…for now.

Physician groups aren’t too happy about  it. The California Medical Association and Texas Medical Association say the policy is unlawful, inconsistent with CPT, and guaranteed to bury practices in busywork. HealthLeaders summed it up plainly: automatic downcoding based on what’s on the claim, then a post-payment appeal with full medical records. In practical terms, this could mean more delay and friction for providers.

Why this needs pushback

Diagnosis is not a crystal ball. AMA E/M leveling is based on time or medical decision-making. A “simple” final diagnosis can follow complex work that absolutely qualifies for 99215. Using claim-level criteria as a gatekeeper ignores that reality.

It shifts labor and risk to practices. Cigna pays the lower level upfront and asks you to appeal to get back to the original code. That effectively shifts the cash-flow burden to the practice, and a time sink for the staff.State societies are already warning that this will delay payment and raise admin costs.

It’s not just “a few bad actors.” Even Cigna’s “less than 3%” talking point still means edits will hit plenty of legitimate claims, because they plan to apply the screen to everyone. In 2025, when margins are tight, every dollar matters.

It hits specialties we actually serve. Early pushback includes rheumatology and podiatry, both heavy on chronic, complex care where high-level E/M visits are common. Rheum, GI, neuro, cardiology, complex primary care? Expect disruption.

What can your practice do right now

• Audit Cigna remits daily. Flag any 99214/99215 or 99204/99205 payment that comes back one level lower than billed. Build a weekly report. 

• Make the note bulletproof. If you leveled by time, write the total time and qualifying activities clearly. If you leveled by MDM, make the problems, data, and risk obvious in the first five lines. 

• Have an appeal kit ready. Cover sheet, claim line, original code rationale, visit note. Keep templates for Time and MDM so staff can swap in the specifics. Cigna’s own page explains that you must send the full record to reverse the downcode.

• Escalate with your society. CMA, TMA, AMA and others are already on record. Add your data so the story is volume plus impact, not anecdotes.

Thrivory’s take, and how we can help

This is the kind of “accuracy” that quietly shaves payments and slows cash flow. That combination hurts access and growth — and it’s exactly where Thrivory can lean in.

• Proactive monitoring, not just cleanup. Because we integrate with PMS systems and watch claim flows, we can track your Cigna E/M lines for 99204-99205, 99214-99215, 99244-99245, and alert you the moment a payment comes in one level lower than billed. Think of it as an R49 Watchlist with weekly dashboards and a live feed into your billing queue.
  
  

• Pre-submission “R49 risk” hints. Using our claims intelligence, we can flag combinations Cigna is likely to question and nudge your team before the claim goes out (“Time not explicit – add total minutes” or “MDM risk unclear – cite management risk or data review”).
  
  

• Specialty heatmaps. We’ll monitor and publish periodically a running view of downcoding rates by specialty and state, and spotlight high-risk segments that overlap with our core base (rheum and GI infusion practices included.)
  
  

• Cash-flow buffer while you fight. If you’re hit with a wave of downcodes, we can still advance on those encounters and settle when the appeal pays. The policy creates delays by definition; our design neutralizes delay.

You shouldn’t have to be your own claims detective. Thrivory turns this into a solvable problem.

Final Thoughts

At the end of the day, I believe Cigna is actually trying to make it easier to get paid.  It remains to be seen whether this policy will achieve that. Still, it’s hard not to meet the stated goal of “reducing administrative burden” with a bit of cynicism, especially when they hand us a fax number.

Practices shouldn’t have to jump through hoops to be paid correctly for complex care.

We’ll keep working with clients to monitor the impact and adapt.

Talk to Us

Not long ago, we met with a potential client for the first time. During that meeting, we walked her through the difference between Thrivory and many other lenders. We explained how some companies offer fast money but hide the real cost behind confusing terms, high rates, and full recourse clauses that put all the risk back on the business.

A few weeks later, she sent us a note thanking us for warning her about one of those lenders. While shopping for a loan on the web, she got an offer of $50,000 with repayment over 14 months at $1,400 per week.

At first glance, it looks reasonable, right? But when you do the math, that’s a 60% rate. When converting it to APR, that’s a whopping 169%. She told us the only reason she checked the numbers was because of our conversation. I’m happy to report we were able to help her with a significantly lower rate.

Another prospect told us last week about an even more frustrating experience: They spent over six weeks going back and forth on a loan application, sending documents, answering questions, and thinking they were almost at the finish line. Only later did they learn the company was not the lender at all, but a broker.

By the time they reached the actual lender, the terms had changed completely. The rate was higher, the repayment was shorter, wasting weeks of time and effort…

These situations happen more often than they should. Based on our experience, here are five things every business owner should watch for before committing to financing:

Always do the full math

Do not stop at the quoted rate. When evaluating offers from lenders, it’s essential to perform your own calculations to uncover the true cost of the funding. Hidden items such as origination fee, disbursment fee, pre-payment fees…  These structures can mask a far more expensive reality, making it difficult to compare different financing offers side-by-side. If a lender is unwilling to assist with a full cost breakdown, that is a major red flag of hidden costs.

Match repayments to your revenue cycle

A working line should support your cash flow, not suffocate it. Many lenders push daily or weekly repayment schedules that can look small in isolation but can drain your working capital quickly.

If your revenue comes in monthly, a weekly debit will create constant stress. Ask how repayment aligns with your receivables. A responsible financing partner will structure payments around the rhythm of your business, not theirs.

Learn who you are dealing with

It is important to know whether you are working directly with a lender or through a broker. A broker might promise the world but has no control over the actual terms. This can lead to surprises, delays, and higher costs.

If you are unsure, ask directly: “Are you the lender, or are you placing me with someone else?” Knowing who ultimately sets the terms will save you from wasted time and unpleasant surprises.

Speed is not always a good thing

“Cash tomorrow” sounds great until you realize the price you are paying for it. Many companies use speed as a selling point because they know it distracts from the true cost.

Of course, fast funding matters, especially when your expenses do not wait, but fairness and transparency should come first. If the offer feels rushed or too good to be true, step back and review the details carefully.

Choosing a partner, not a lender

Financing is more than just getting money in bank. It is about working with someone who understands the industry, respects your goals, and can structure a solutions that supports your growth.

A good partner will explain the terms clearly, answer your questions directly, and tell you when a product may not be the right fit for you, even if that means sending your somewhere else. When you find a financing company that acts as an advisor rather than a salesman, you know you are in the right place.

Our shameless plug 🙂

At Thrivory, we’ve learned that educating our clients is one of the most powerful things we can do. When they understand the numbers, the terms, and the hidden pitfalls of an unforgiving industry, they can make choices that protect their business. Knowledge is power, and having the right information at the right time can save your business from costly mistakes.

If you are exploring financing, we are committed to being a trusted partner for practices that want funding designed around growth, not traps. Whenever you’re ready, we are here to help you find a smarter path forward. 

Talk to Us

For about 30 seconds, we celebrated. Then we opened the rule and saw the line that matters:

“…payment for codes that are not based on physicians’ time will decrease by 2.5 %.” (Axios)

Cue record scratch.

Headline Math vs Real-World Math

+3.8 % applies mainly to time‑based E/M visits (think family medicine or psych.) ‑2.5 % hits the work RVUs of almost every procedure code our clients rely on: infusion, imaging, skin grafts, and outpatient surgery. (American Hospital Association, American College of Cardiology)

If your practice is procedure-heavy, the average infusion for Remicade that used to net your practice $2,000 is now losing $50 per dose. Multiply that across monthly volume, and the “raise” quickly becomes a six‑figure haircut.

Why the Timing Could Not Be Worse

Medicare cuts are painful in any year, but doing it while the Fed keeps overnight rates parked between 4.25 % and 4.50% magnifies the squeeze. Every extra day those claims sit in limbo costs more in borrowing or missed opportunity. (Reuters)

Three Moves to Get Ahead of the Cut

1. Model the Dip Now
   Run a quick scenario: take your top ten CPTs, shave off 2.5 percent, and project a 90-day reimbursement delay. The delta is your new liquidity gap.
    

2. Accelerate What You Already Earned
   Converting aged AR into same‑day cash lets you sidestep both the rate hike and the CMS haircut. You keep reserves intact and fund growth instead of plugging holes.
    

3. Speak Up Before September  12
   CMS is still in the comment period. Specialty societies will file letters, but individual practice stories are also important. A two-paragraph submission explaining how a 2.5 percent cut affects patient access carries weight. (Axios)

The Bottom Line

CMS gave primary care a raise and handed the bill to procedure-driven groups. Waiting for Congress to fix it is not a strategy. Leveraging your earned claims today keeps you agile tomorrow—no matter what the final rule looks like.

If you’d like to see what an AR advance would look like against your fee schedule, let’s talk.

We can run the numbers in one quick call and show exactly how much margin you can put back into patient care and growth. 

Talk To Us

“We’ve got enough money in the bank. Why would we need to advance our claims?”

It’s a fair question. If your practice is financially healthy, advancing your claims might sound unnecessary. But as we talked it through, the real question emerged: Are you using your cash in the smartest way possible?

Don’t Park Your Revenue

The truth is, this isn’t about needing cash. It’s about using it wisely. Having hundreds of  thousands of dollars sitting in unpaid claims is like parking your revenue in a no-access zone. That money has already been earned, but you can’t use it. Not for growth, not for reinvestment, not even for daily operations. Reimbursement timelines can be slow and unpredictable. The result? Your practices could be hiring, expanding, or reinvesting in better care. Even if your bank balance looks solid, your money might not be working as hard as it could be.

Leverage Without Liability

Just because you can dip into reserves doesn’t mean you should. Your cash reserves exist to protect your practice. Burning through them to cover insurance delays doesn’t make sense. Payer audits, staffing changes, or a revenue dip can put pressure on even the most stable practices.

One of our clients learned this the hard way. They’d just opened a second location and had planned everything down to the dollar. However, when a major scheduled payment didn’t clear, payroll was suddenly at risk. With only hours to spare, they reached out to us. We reviewed their outstanding claims, and we got them the funds they needed deposited the same day.

They were well-run. They had reserves. However, when the unexpected happened, that buffer proved to be thinner than it looked.

Growth Needs Agility, Not Just Capital

Growth means spending. Whether you’re hiring, adding locations, or upgrading equipment, it all takes capital. If you’re pulling from your reserves every time an opportunity comes up, you’re shrinking your margin for error.

There’s a difference between being fine and being ready. The more flexibility you keep in your back pocket, the more confidently you can move when something important comes up… Whether it’s planned or not.

Clearer Picture, Fewer Surprises

Unfortunately, many practices don’t have a live view of what’s owed to them. Which claims are aging? Which are collectible? What’s been delayed?

If you’re only seeing your numbers after the fact, it’s harder to plan ahead. It’s not just about getting paid faster. It’s about knowing where you stand in real time so you can make better decisions in the moment, not just at month-end.

So back to the question: If you already have cash in the bank, why bother advancing claims?

Because it’s not about needing the money. It’s about leveraging what you’ve already earned to work smarter, move faster, and stay prepared.

We’ve worked with practices that had strong financials and excellent revenue cycle management. However, what made the difference at the end of the day wasn’t how much they had in the bank. It was how well they used it.

Accelerating your claims doesn’t mean you’re in trouble. It means you’re being proactive. It means that you’re keeping your reserves intact. It means you’re avoiding unnecessary debt and are giving yourself the flexibility to move when the moment calls for it.

Sometimes, the smartest time to act is when you don’t have to. If you’re in a good place, that’s the perfect time to make sure you’re set up for what’s next.

We’re here when you’re ready to talk.

Talk to Us

A Global Supply Chain for Medications

Modern medicine is a globally sourced endeavor. A huge share of drugs used in the U.S. are manufactured or sourced abroad. In fact, about 40% of finished medications and 80% of active pharmaceutical ingredients (APIs) for U.S. drugs are produced overseas. The United States imported approximately $168 billion worth of pharmaceutical products in 2022,more than any other country. This heavy reliance spans multiple regions: China and India supply the bulk of generic medicines and raw ingredients, while many brand-name drugs rely on components made in Europe (for example, Ireland is a major hub for producing active ingredients of blockbuster drugs).

In short, America’s medication supply chain is truly international. China is the world’s largest producer of APIs, and India is a dominant manufacturer of generic finished drugs . Even critical antibiotics and basic generic medications are often manufactured in China or India . Europe plays a key role for high-value pharmaceuticals: numerous innovative or brand-name therapies for the U.S. market are formulated partly in European facilities . This global interdependence means any disruption to trade – like tariffs – can have an outsized impact on availability and cost.

Tariffs Spike Costs from Ingredients to Finished Drugs

With such an overseas-dependent supply chain, aggressive tariffs on imports act like a sudden tax on the entire medication production process. It’s important to note that the new U.S. tariffs technically exempt finished pharmaceutical products themselves, but not the ingredients and materials used to make them. That distinction offers little comfort to manufacturers and providers: if the chemical ingredients, precursors, or packaging for a drug are hit with a 125% surcharge (on top of existing duties) when coming from China, the effective cost of the final medicine will jump accordingly.

Healthcare and economic experts warn that these import taxes will increase costs and may worsen drug shortages. The logic is simple: manufacturers facing steep new costs must either raise prices or, if margins were slim, stop producing certain products. Generic drug makers are especially vulnerable. They often operate on razor-thin profit margins and “simply can’t absorb new costs,” according to the Association for Accessible Medicines. 

According to Wolfgang Koester, Chairman of the Board of Directors at Thrivory and a global markets expert with over 30 years of experience advising Fortune 1000 companies and governments, “Trade tariffs also introduce significant volatility into the cost structures of healthcare providers. Infusion centers and specialty pharmacies, often bound by fixed reimbursement contracts, face financial strain as they are unlikely to adjust swiftly to these cost fluctuations. This scenario underscores the necessity for reviewing and likely add flexibility in order to maintain the financial  and operational stability while ensuring uninterrupted patient care.”

Many low-cost generics are already sold at near break-even prices; an added tariff expense could turn them unprofitable. Industry data show the total value of generic drug sales in the U.S. actually fell by $6.4 billion over five years (despite growing volume), illustrating how constrained generic pricing is – and “tariffs would make this much worse,” the industry group CEO warned . In practical terms, some generic manufacturers might exit the market rather than operate at a loss, which would exacerbate existing drug shortages and drive prices higher for essential medications .

Even for higher-priced brand-name and specialty drugs, tariffs add pressure. Manufacturers of these drugs may have more cushion, but over time the added costs will trickle down. Pharmaceutical distributors, for example, work on extremely slim margins (around 0.3% net margin on average) . They cannot easily absorb a double- or triple-digit increase in import costs, so they will pass those costs along to pharmacies, hospitals, and clinics. In turn, payers (insurers, government programs) will face higher expenditure, and eventually patients could see higher co-pays or limited access. Multiple analyses have suggested that sweeping tariffs on healthcare imports could sharply inflate U.S. healthcare prices and even impede innovation and access to therapies .

Supply Chain Reality: Rising Costs and Fixed Contracts

For infusion care centers and specialty pharmacies, the situation is especially precarious. These providers often operate under fixed-price contracts or set reimbursement rates that cannot be adjusted quickly even as their underlying costs spike. In other words, an infusion clinic might be locked into a contract with an insurer or healthcare network to provide a certain therapy at a fixed rate, or a specialty pharmacy might have agreed-upon pricing with a pharmacy benefit manager. If drug prices surge suddenly due to a tariff, these contracts offer little immediate flexibility to raise billing rates.

Industry experience during recent crises underscores this vulnerability. The National Home Infusion Association (NHIA) notes that many infusion therapy providers receive a bundled per-diem payment covering drugs, supplies, and services for each patient-day . During the COVID-19 pandemic, for example, prices for certain IV nutrition components and disposable supplies jumped dramatically (some nutrients rose ~50% in cost over five years) due to global shortages . Yet the reimbursement to providers remained a fixed daily amount, “with almost no flexibility to offset the rapid increases in acquisition costs” . In effect, infusion centers had to eat the extra cost, eroding their margins and threatening the sustainability of care. As NHIA concluded, even a well-designed flat-rate payment model “leaves providers vulnerable to economic shocks” when input costs surge unexpectedly .

Tariff-driven cost increases would create a similar shock. Infusion centers buying IV drugs or supplies from overseas could suddenly pay significantly more (up to 145% more for Chinese-sourced items) but still be reimbursed the old price under insurance contracts. For instance, an oncology infusion clinic that contracts at a fixed rate per chemotherapy infusion can’t simply add a surcharge mid-year because the drug’s import cost went up – the contract likely prohibits such ad hoc price changes. This mismatch means providers either absorb the loss or delay/cancel treatments, neither of which is tenable for long.

Specialty pharmacies face analogous challenges. These pharmacies dispense high-cost, often life-sustaining medications (for conditions like autoimmune diseases, rare disorders, etc.) and usually have agreements with health plans or pharmacy benefit managers (PBMs) that set the reimbursement formula. Pharmacy pricing for insured patients is determined by contracts with each PBM or government payer . If a specialty pharmacy’s cost to acquire a drug suddenly exceeds the contracted reimbursement (due to a tariff hiking the import price), the pharmacy must operate at a loss to fill that prescription or consider not dispensing that medication at all . Pharmacies cannot unilaterally raise the price on an insurer-covered drug outside the contract; doing so would breach the agreement and likely drive patients elsewhere. In practice, when faced with such losses, some pharmacies might attempt to shift costs in other ways (e.g., increase cash prices for uninsured patients) or opt to leave the network for that drug . For a specialty pharmacy, a sudden cost jolt erodes the viability of providing certain therapies, especially if multiple drugs are affected simultaneously by broad tariffs.

Looking Ahead: Navigating the Tariff Impact

As these tariffs roll out, healthcare providers and policymakers are bracing for impact. Industry groups are already urging the administration to grant exemptions for critical medications and components, warning that patient care is at stake . There is also renewed interest in bolstering domestic manufacturing of pharmaceuticals to reduce reliance on foreign supply, a goal the Trump administration touts. However, shifting drug production to the U.S. is neither cheap nor fast – building new manufacturing facilities can take 5 to 10 years and billions of dollars . In the meantime, hospitals, infusion centers, and pharmacies will need contingency plans: diversifying suppliers where possible, renegotiating contract terms to account for extraordinary cost increases, and advocating for policy relief if shortages loom.

For operators of infusion care centers and specialty pharmacies, the key is awareness and agility. Understanding that a policy change far upstream – like a tariff on Chinese chemical imports – can directly hit your bottom line is crucial. Fixed-price contracts should be revisited with payers to include clauses for sudden cost inflation (similar to how force majeure works) so that providers aren’t left holding the bag on massive surcharges. Where feasible, providers might stockpile essential medications or supplies before tariff deadlines (indeed, some drugmakers have flown in extra inventory ahead of tariff implementation) . Collaborating with group purchasing organizations (GPOs) and wholesalers to find non-tariffed sources (e.g., sourcing from India or Europe if Chinese APIs become too costly) is another short-term mitigation strategy.

In summary, the 145% tariff on Chinese imports represents a seismic shake-up for medication supply chains. Because so many pharmaceuticals and their ingredients are made overseas, these tariffs function as a sudden price hike on lifesaving products . Medication costs are expected to rise, and providers with rigid pricing contracts face a squeeze in absorbing those increases . Infusion centers and specialty pharmacies, in particular, must prepare for the possibility of higher acquisition costs that they can’t immediately pass on. Ultimately, while the tariffs aim to strengthen domestic production in the long run, in the near term they threaten to increase healthcare costs for payers and patients alike and put added financial strain on the very facilities that deliver critical therapies . Healthcare leaders and policymakers will need to work together so that trade policy doesn’t unintentionally compromise patient care or the viability of specialty treatment providers.

Sources:

1. Euronews – White House clarification on tariff rates

2. Reuters – Trump trade war targets prescription drugs

3. GAO/FDA data via NTU – Overseas manufacturing of drugs

4. The American Journal of Managed Care – Tariffs’ impact on healthcare costs

5. National Home Infusion Association – Impact of cost increases on infusion providers

6. U.S. Pharmacist – Fixed reimbursement contracts and pharmacy losses
   

The Pain of Payment Chaos in Medical Practices

Small and mid-sized healthcare practices face unique challenges in getting paid. Healthcare costs are higher than ever – U.S. healthcare spending hit $4.8 trillion in 2023 (about $14,423 per person) – yet a huge chunk of that is swallowed by bureaucracy. In fact, over one-third of all healthcare costs in the U.S. go to administration (insurer overhead, billing, coding, etc.). For a practice with limited staff, that administrative bloat isn’t just a statistic; it’s a daily reality.

Why is billing so cumbersome? A big culprit is the lack of standardization. Harvard economist David Cutler famously compared our patchwork payments system to a grocery store where “every health insurer requires a different bar-code-equivalent and payment-systems submission” (How fintech can transform healthcare payments – United States – English). In other words, every payer has its own forms, codes, and portals. This complexity forces even providers to hire billing specialists just to file claims and chase down payments. It’s an expensive, time-consuming hassle.

Meanwhile, the rise of high-deductible insurance plans means practices rely more on patients to pay directly – and many patients struggle to keep up. One industry report noted that patients with high deductibles often don’t budget for medical bills as they would under low-deductible plans. Not surprisingly, some patients simply delay or skip payments altogether. A recent study found 33% of patients put off needed healthcare mostly because they couldn’t afford the costs upfront. For a practice, that can mean more unpaid bills and write-offs.

All this adds up to a cash-flow headache. Slow reimbursements from insurers, delayed or missing payments from patients, and mountains of paperwork in between. Doctors and office managers end up spending evenings and weekends on billing. (A 2018 survey showed 70% of doctors spend 10+ hours per week on paperwork.) It’s easy to see why burnout is rampant and why many small and mid-sized practices feel financially squeezed.

Fintech to the Rescue: Automating the Revenue Cycle

Enter fintech – the marriage of finance and technology – with a promise to simplify and streamline healthcare payments. Fintech companies and platforms are tackling the inefficiencies of the traditional RCM process head-on, and even small practices can reap the benefits. In fact, modern RCM automation is scalable and accessible to organizations of any size, “beneficial for small practices by reducing errors, improving cash flow, and freeing staff for patient care” (Healthcare Revenue Cycle Automation: Boost Efficiency with AI & RPA).

So, how exactly can fintech transform a clinic’s payment process? The key is automation and digital integration. Instead of paper statements and manual data entry, digital payment platforms create a seamless flow from patient billing to payment posting:

• Automated Invoicing & Claims: Platforms like Camber can auto-generate bills and even file insurance claims with minimal human input. This reduces human error (no more typos in codes or missed charges) and speeds up reimbursement. As one analysis noted, fintech can accomplish this through automated invoicing, billing and payment processes that eliminate manual inputs – and simply cutting out human errors can speed up claims and help providers get paid faster. A cleaner claims process means fewer denials and quicker turnaround from insurers.
  

• Shorter Revenue Cycles: Digital payments take the waiting out of billing. Rather than mailing an invoice and hoping a check comes back in 60 days, practices can send electronic bills instantly and often get paid just as fast. Fintech solutions like Thrivory create what is essentially a real-time payments system for healthcare. This level of transparency and immediacy shortens the revenue cycle dramatically. According to Convera, digital payment tools streamline the process and allow patients to understand their coverage and schedule payments or pay balances in installments, while ensuring providers send bills to the right payer promptly. The result is that providers aren’t left waiting and wondering – they know when a payment is scheduled and can better predict cash flow.
  

• Data Integration & Interoperability: One reason offices drown in admin work is that systems don’t talk to each other. Fintech is changing that with more interoperable designs (often leveraging open banking APIs and healthcare data standards). In plain English, this means your billing software, patient portal, bank, and even EHR can share relevant info securely. No more manually reconciling accounts or double-entering data with solutions like Anatomy. For example, some platforms like Flychain integrate with (or even replace) QuickBooks or practice management systems to automatically log transactions. When a patient pays their bill online, the ledger updates automatically – saving your office manager the step of bookkeeping. Fintech’s emphasis on integration also means less paper overall. (About half of U.S. patients still receive old-fashioned paper medical bills by mail, even though 79% say they’d prefer to pay all their bills in one digital location. Fintech solutions are closing this gap by offering the unified digital experiences consumers clearly want.)
  

Crucially, these innovations maintain security and compliance behind the scenes. The best healthcare fintech tools are HIPAA-compliant, using encryption and secure authentication, so practices don’t have to worry about trading security for efficiency. The bottom line is that automation is taking over the heavy lifting of RCM. Instead of piles of claims and invoices, you get a smoother flow of funds from patients and payers to your bank account – with far fewer staff hours expended.

More Time for Patients, Less on Paperwork

Perhaps the most profound impact of automated payment solutions is the gift of time. Every hour your practice saves on billing and insurance tasks is an hour gained for patient care (or at least an hour saved from your team’s stress levels). Fintech is effectively outsourcing the busywork to software – and doing it faster and often more accurately than a human could.

Consider this: 10 hours a week on paperwork (the figure 70% of physicians reported) adds up to 480+ hours a year. That’s a lot of clinic time that could be spent seeing additional patients, coordinating care, or just improving work-life balance for you and your staff. By automating much of the RCM process, fintech shrinks that administrative load. Claims go out faster, payments come in sooner, and many tasks (like verifying insurance eligibility or sending out receipts) happen in the background without manual effort.

Accuracy also improves, which has a domino effect on efficiency. Fewer billing errors means fewer claim denials to chase and fewer patient phone calls about mistakes. As fintech expert Joe Tuan explains, by reducing errors and improving workflow, automation in RCM directly leads to better cash flow and frees staff to focus on patient care. In a small practice, you might not have a dedicated billing department – it could be your front-desk person doubling as billing specialist. Taking those repetitive tasks off their plate allows them to concentrate on scheduling, patient outreach, and other valuable activities that a machine can’t do.

One overlooked benefit is the data these digital systems provide. When your payments are handled through modern platforms, you gain real-time visibility into your financial performance. You can easily see metrics like days in A/R (accounts receivable), collection rates, or outstanding balances by age. Sophisticated fintech systems even use analytics to flag trends – for example, if a certain insurance company is slow to pay or if a type of procedure is often denied. Having this information at your fingertips allows practices to make quicker decisions (perhaps time to drop a bad payer contract, or to follow up with certain patients sooner). Traditional RCM often left small providers in the dark until problems became severe. Fintech brings actionable insights, typically through simple dashboards. As a result, managing the business side of a practice becomes less reactive and more proactive.

Most importantly, reducing administrative strain helps combat burnout. Doctors and staff can end their day when the last patient leaves, rather than staying late to tackle billing logs. As one healthcare CEO put it, “with proper use of fintech, medical professionals can spend less time on administration and more time on quality care.” (Top 4 Ways Fintech is Enhancing Healthcare | Plutus Health Inc) For anyone who’s felt the creep of paperwork into their personal time, that’s a game-changer. It means a healthier work environment and potentially better patient outcomes too – because a practice that isn’t financially stressed or overwhelmed by admin is more likely to deliver attentive, focused care.

Key Takeaways: Fintech Transformations in Medical Practice Payments

• Automation Accelerates Cash Flow: By digitizing and automating billing, claims, and collections, fintech shortens the revenue cycle. Fewer errors and instant transactions mean faster payments – insurers pay more quickly and patients are prompted to pay promptly, boosting cash flow.
  

• Less Admin Work (and Less Burnout): Fintech payment solutions dramatically cut down manual tasks. Practices can reduce tedious billing work (one report shows RCM automation is feasible even for small clinics, freeing staff for patient care) and avoid the nights/weekends spent on paperwork. This leads to lower stress and allows your team to focus on clinical duties and patient interaction.
  

• Higher Collection Rates: Offering flexible payment options (online payments, payment plans, financing) translates to more bills being paid. Patients are more likely to follow through when they have easy ways to pay or can spread out a big bill. Fintech-facilitated plans have been shown to increase collection rates and even speed up payments to providers, meaning fewer receivables languishing in the books.
  

• Improved Patient Experience: A smooth, transparent payment process is part of great patient service. Fintech tools help demystify medical bills and provide convenient channels to pay – meeting patients’ expectations (remember that 79% of consumers want a one-stop digital platform for bills). Patients who find billing easy and fair are more likely to stay loyal to a practice and recommend it to others. In this sense, simplifying payments isn’t just a finance win, it’s a marketing win too.
  

• Future-Ready Practices: Embracing fintech now positions medical practices for the future of healthcare. As trends like telehealth, high deductible plans, and consumer-centric care continue, having a robust, tech-driven payment infrastructure will be critical. It ensures you can adapt to new models (like subscription-based care or outcome-based payments) with minimal friction. Essentially, fintech gives even a solo practice the tools of a big healthcare system, leveling the playing field in business operations.
  

A Closing Thought

At the end of the day, simplifying healthcare payments is about freeing practices from the admin swamp that’s been dragging them down for years. Fintech isn’t some far-off promise; it’s here now, delivering real improvements in how doctors get paid and patients pay for care. A process that used to be defined by paper cuts, phone tag, and long waits is turning into one of instant notifications and seamless clicks. For a small practice struggling with limited staff and tight margins, these changes are nothing short of transformative. It means fewer billing headaches, steadier cash flow, and more time for what truly matters – caring for patients. In a healthcare environment where every minute and every dollar counts, fintech-powered payment solutions might just be the prescription for success that medical practices have been waiting for. And that’s something worth sharing.

Sources
U.S. healthcare spending rises to $4.8 trillion in 2023, outpacing GDP | Reuters
More than a third of U.S. healthcare costs go to bureaucracy | Reuters
How fintech can transform healthcare payments – United States – English
The Biggest Revenue Cycle Challenges for Small Practices
FinTech Financing Options Ease Healthcare Practices’ Payer Pains | PYMNTS.com
Top 4 Ways Fintech is Enhancing Healthcare | Plutus Health Inc
Healthcare Revenue Cycle Automation: Boost Efficiency with AI & RPA
Fintech in Healthcare: A Game Changer for Patient Services

Thrivory provides innovative financial solutions tailored for healthcare providers, focusing on optimizing financial performance and mitigating risk. Core offerings include:

• Revenue-Based Financing: Thrivory offers flexible, non-debt financing solutions based on a practice’s revenue cycle. This provides access to working capital without the burden of traditional loans, allowing practices to invest in growth and operations.

• AI-Powered Financial Insights: Thrivory leverages artificial intelligence to analyze financial data and provide actionable insights. These insights help practices identify areas for improvement in revenue cycle management, optimize billing practices, and make data-driven decisions.

• Risk Mitigation Strategies: Thrivory helps practices minimize financial risks by identifying potential revenue leakage points and implementing strategies to improve cash flow and reduce bad debt. This includes analyzing payer contracts and identifying opportunities to maximize reimbursements.

• Personalized Support: Thrivory provides dedicated support to each practice, offering guidance and expertise to navigate the complex healthcare financial landscape. Their team works closely with practices to develop customized solutions that meet their specific needs.

Nsure offers a comprehensive suite of payment processing solutions designed specifically for healthcare practices. Their services include:

• Demographic Verifier: By using this software during the time of pre-billing, providers reduce their denials and rejections from payers caused by mis documented information. 

• Self Pay Analyzer: Providers using this service are able to identify patient payment likelihood. 

• Insurance Discovery: Identify active, billable insurance on an average of 37% more self-pay. Utilizing insurance discovery, collectively, our clients collect millions of dollars more, every year.

• Insurance Verifier: Providers using our insurance verifier no longer have to use multiple payer websites to check eligibility. By running eligibility during the pre-billing process, our providers experience higher clean-claim rates.

• Robotic Process Automation: Turn your repetitive and mundane tasks into automated processes, saving you millions of dollars in payroll and significantly improving your operational efficiency.

Together, we are committed to providing healthcare practices with immediate access to capital and efficient payment solutions, reducing financial uncertainties and administrative complexities.

“This partnership represents a significant step forward in our mission to support independent medical practices,” said Devon Seitz. “By combining our financial expertise with Nsure’s innovative payment platform, we can offer comprehensive solutions that enhance the operational efficiency and financial health of healthcare providers.”

Michael Ciullo, CEO of Nsure, added, “Our collaboration with Thrivory aligns perfectly with our goal to empower healthcare providers through technology. By extending their capital acceleration solution to medical practices, we aim to simplify their financial processes, allowing them to focus on what matters most—patient care.”

We look forward to the positive impact this partnership will have on the healthcare community, providing practices with the tools they need to thrive in an ever-evolving industry.

For more information on how Thrivory can help your healthcare practice thrive, contact us today

Visit NSure to learn more about their products and services

This remarkable achievement is a testament to:

• A Robust Model: Our innovative approach to healthcare payments addresses the unique challenges faced by providers and patients.

• A Cutting-Edge Product: We leverage the latest technology, including AI, to streamline processes and deliver a seamless, user-friendly experience.

• Client-Centric Focus: We actively listen to our clients’ needs, creatively solve their challenges, and prioritize accountability and responsiveness.

Breaking Down Barriers to Healthcare Financing

Traditional healthcare financing options often involve cumbersome diligence processes and lengthy onboarding procedures. At Thrivory, we’ve eliminated these barriers, making it easier than ever for providers to access the capital they need.

Here’s the secret sauce that sets Thrivory apart:

1. Your Way, Always: We understand that changing your existing payment and accounting processes can be a major headache. That’s why we designed Thrivory to seamlessly integrate with your current systems. No disruptions, no fuss – just a smooth flow of funds.

2. Honesty and Transparency are Key: In the world of finance, trust is everything. We believe in open communication and clear, straightforward practices. No hidden fees, no surprises – just honest, transparent partnerships.

3. Your Feedback Fuels Us: We’re not just here to meet your needs; we’re here to exceed them. We actively seek your feedback and use it to constantly improve our platform and services. Your success is our top priority.

4. Happy Team, Happy Clients: We foster a positive and supportive work environment where our team members can thrive. This translates into a passionate team dedicated to providing you with exceptional service and support.

See what our clients have to say about working with Thrivory: 

• “Thrivory have been a fantastic partner in helping us achieve our financial goals”

• “Partnering with Thrivory allows us to further streamline our operations and ensure resources are readily available to deliver the highest quality infusion services. This partnership is a game-changer for both Allied Infusion and our patients.”

• “Getting funding from Thrivory was incredibly simple. Their process was straightforward, and we received the support we needed quickly. The detailed reporting they provide has been great and gives us the clear insight we need to navigate our financial needs.”

We’re fortunate to have the best clients and partners in the industry. By choosing Thrivory, you’re not just selecting a payment platform; you’re joining a community dedicated to improving access to quality healthcare.

For more information on how Thrivory can help your healthcare practice thrive, contact us today

A Resilient Foundation

One of the most striking findings from our survey is how many independent practices have flourished without taking on traditional bank loans. This underscores two essential truths:

1. Strong Financial Management
   Many practices have built healthy financial foundations—using conservative growth strategies, reinvesting profits, or leveraging partner contributions rather than debt.

2. Need for Alternative Financing
   Despite this resilience, limited access to capital can also hamper growth. Particularly for practices aiming to expand services or adopt new technology, securing flexible financing remains a hurdle.

From our broader industry research, this trend echoes the fact that smaller, physician-owned clinics often rely heavily on retained earnings or partner capital rather than complicated debt structures. According to a 2024 study by the Medical Group Management Association (MGMA), over 60% of independent practices rank “financial stability” as their top concern in the year ahead—solidifying the importance of tailored financing solutions.

Strategic Investments: Equipment and Facility Upgrades

For the clinics that have taken out loans or secured financing, the focus has been on strategic, high-impact investments. Two main categories stand out:

1. Equipment Upgrades
   Practices allocate funds toward purchasing modern technology (such as updated imaging devices or telehealth systems) to enhance patient care, boost efficiency, and potentially increase profitability.

2. Facility Expansions
   By expanding their physical footprint, clinics can accommodate growing patient volumes, offer new services, or improve patient experiences—key differentiators in an increasingly competitive market.

When used wisely, these investments can generate solid returns. Updated equipment reduces maintenance costs, improves diagnostic accuracy, and can attract new patients, while a larger or renovated facility often leads to higher patient satisfaction.

Loan History & Challenges: High Interest Rates and Collateral

Despite the strategic value of loans, our survey confirmed that securing financing can be daunting. High interest rates—driven partly by Federal Reserve policy changes—remain a top deterrent, particularly for practices accustomed to cautious budgeting. In addition, personal collateral requirements emerged as a major sticking point, with many practice owners wary of risking personal assets to secure a loan.

Key Financing Obstacles

• High-Interest Rates: Even a small increase in APR can translate into significant additional costs over the life of a loan.

• Personal Collateral: Traditional lenders often require guarantees, causing many independent physicians to hesitate.

Given these hurdles, it’s no surprise that a sizable share of practices have steered clear of debt entirely or delayed borrowing until absolutely necessary.

Information Sources & Decision Factors

In evaluating financing options, practices overwhelmingly rely on local banks and healthcare consultants. Local banking relationships often offer the advantage of familiarity and trust, while consultants can tailor advice to the unique regulatory and operational environment of healthcare. That said, many independent practices also express interest in exploring alternative lending platforms, particularly those that specialize in healthcare, as they may better understand the nuances of reimbursement, compliance, and patient-volume fluctuations.

What Practices Consider Most

1. Interest Rates & Fees

2. Repayment Terms & Flexibility

3. Total Cost of Capital

4. Speed & Ease of Approval

Thrivory: A Unique Alternative

Traditional loans, even those labeled as “alternative lending,” often carry restrictive terms—high interest rates, personal guarantees, and sometimes a pledge of all business assets. This is where Thrivory comes in as an appealing alternative:

• Lower Barriers to Approval: Thrivory is designed to make financing more accessible without demanding onerous collateral obligations.

• Competitive Rates: By focusing on independent practices and understanding their revenue streams, Thrivory can often offer more attractive terms.

• Cash Flow Support: Thrivory structures repayment in a way that aligns with a practice’s financial realities, providing greater flexibility.

As a result, practices can obtain the capital they need—whether for equipment investments, facility expansions, or operational improvements—while mitigating the risks often associated with traditional bank loans.

Practice Structure & Long-Term Outlook

Our survey also revealed that 70.4% of respondents are physician-owned practices, with the rest divided between those owned by health systems/hospitals and those affiliated with corporate multi-group structures. Notably, the vast majority of respondents reported operating for more than five years—a testament to their stability and resilience in a rapidly changing healthcare marketplace.

Yet, with an uncertain reimbursement landscape, ongoing regulatory shifts, and potential further interest rate hikes, the question remains: How can independent practices maintain their edge in 2025?

1. Conservative Borrowing with Clear ROI
   Carefully model out potential earnings and patient volume before taking on debt.

2. Tech-Focused Upgrades
   Telehealth, cybersecurity measures, and robust EHR systems will remain competitive advantages.

3. Strategic Partnerships
   Collaborations or selective affiliations can help spread costs, share expertise, and mitigate financial risks.

Key Takeaways

1. Financial Strength & Resilience: A substantial number of independent practices operate without relying on traditional loans—highlighting prudent financial management but also underscoring potential growth constraints.

2. Strategic Loan Utilization: When borrowing, clinics focus on high-impact projects that can amplify patient care and revenue, such as equipment or facility expansions.

3. Overcoming Challenges: Addressing steep interest rates, collateral requirements, and complex loan terms remains an industry-wide priority.

4. Thrivory’s Value: By offering alternative financing solutions without the typical drawbacks of personal guarantees and sky-high interest, Thrivory equips practices to secure the funding they need for continued growth and modernization.

Looking Ahead to 2025

In an environment marked by economic shifts and regulatory changes, financial agility will be key for independent practices. Thoughtful borrowing—backed by thorough ROI assessments—can empower clinics to invest in technology, expand their facilities, and deliver superior patient experiences. However, caution is warranted, given the potential for continued interest rate volatility and ongoing cost pressures.

Many experts predict an increased push for tech-focused transformations in the next year, including telehealth expansions and enhanced data security systems. Securing timely and flexible funding for these improvements can offer a crucial competitive advantage—whether that means attracting new patients, streamlining operations, or complying with evolving regulations.

Conclusion: Thriving in an Evolving Financial Landscape

The data from our 2024 survey illustrates a sector in transition—balancing the opportunities that come with modernization against the realities of tightened lending conditions. Yet, with careful financial planning and access to the right financing tools, independent practices can continue to deliver top-tier patient care while maintaining robust financial health.

Interested in learning more about how Thrivory can help your practice overcome traditional lending obstacles?
Our team specializes in healthcare financing and is ready to guide you through every step of your growth journey. We hope these insights support you as you navigate the ever-evolving financial landscape—so your practice can thrive well into 2025 and beyond.

For more information on how Thrivory can help your healthcare practice thrive, contact us today

OneImaging: Transforming Radiology Access

OneImaging is a revolutionary platform that simplifies access to high-quality, affordable radiology services for employers and their employees. Their comprehensive solution includes:

• A vast network of over 4,800 accredited imaging centers across the nation.

• Seamless integration with existing health plans.

• Dedicated care coordination and appointment scheduling support.

• Significant cost savings of up to $376 per employee per year, with reductions of 60-80% compared to traditional rates.

• Pre-exam guidance and post-exam report management.

By partnering with Thrivory, OneImaging will gain access to our unique financial solutions, enabling them to:

• Fuel Employer Network Growth: Thrivory’s cash acceleration services will provide OneImaging with the working capital they need to aggressively expand their network of employer clients. This will allow OneImaging to reach more businesses and offer their cost-saving radiology solutions to a wider range of employees.

• Unleash Continued Growth: With Thrivory’s support, OneImaging can focus on what they do best – transforming radiology access and improving patient care. They will have the financial freedom to invest in new technologies, expand their service offerings, and solidify their position as a leader in the healthcare industry.

Here is what our CEO’s have to say:

Elan Adler, Co-founder and CEO of OneImaging: “Thrivory’s innovative financial solutions are a game-changer for OneImaging. Their partnership will allow us to accelerate our growth plans and reach even more employers with our cost-saving radiology solutions. Together, we can make a significant impact on the affordability and accessibility of healthcare in America.”

Devon Seitz, CEO of Thrivory: “We are thrilled to partner with OneImaging, a company revolutionizing radiology care delivery. This partnership further underscores the critical need for financial solutions like Thrivory’s within management organizations. By providing OneImaging with the financial tools they need to grow, we’re empowering them to expand their reach and improve patient care. This aligns perfectly with Thrivory’s mission of enabling healthcare organizations to thrive.”

Conclusion

Thrivory is proud to partner with OneImaging to revolutionize radiology access and empower businesses to offer their employees exceptional healthcare benefits. This collaboration is a testament to our shared commitment to improving patient care and driving positive change in the healthcare industry.

For more information on how Thrivory can help your healthcare practice thrive, contact us today

Contact OneImaging to learn more

Allied Infusion: Delivering Excellence in Patient Care

Allied Infusion is renowned for its commitment to exceptional patient care. Their turnkey infusion management services ensure patients receive the best standard of care in a comfortable and convenient environment. Beyond patient well-being, Allied Infusion empowers physicians to deliver better patient outcomes – all while minimizing their workload.

“At Allied Infusion, we prioritize patient care above all else,” says Nidhin Joseph. “Partnering with Thrivory allows us to further streamline our operations and ensure resources are readily available to deliver the highest quality infusion services. This partnership is a game-changer for both Allied Infusion and our patients.”

Thrivory: Bridging the Gap in Healthcare Payments

Thrivory understands the challenges MSOs face, particularly the cash flow struggles caused by delayed payments from clients. Our innovative fintech ecosystem streamlines healthcare payments, ensuring you get paid faster and avoid the burden of upfront costs – especially critical when dealing with expensive medications.

“We’re excited to welcome Allied Infusion as a valued partner,” says Devon Seitz. “This collaboration allows Thrivory to address a critical need in the MSO space. By providing fast and reliable access to capital, we empower MSOs like Allied Infusion to focus on what matters most – delivering exceptional patient care.”

A Synergistic Partnership: A Win-Win for Everyone

The Thrivory-Allied Infusion partnership is a perfect match. Allied Infusion’s dedication to patient care aligns perfectly with Thrivory’s mission to empower healthcare providers. With Thrivory’s innovative financial solutions, Allied Infusion can prioritize patient well-being, invest in growth initiatives, and thrive in a competitive environment.

This strategic partnership ensures:

• Improved Cash Flow for MSOs: Thrivory bridges the gap between delivering treatment and receiving payment, allowing MSOs to avoid cash flow constraints.

• Enhanced Patient Care: Faster reimbursements free up resources for MSOs to focus on delivering high-quality infusion services.

• MSO Growth & Innovation: Thrivory’s flexible funding allows MSOs to invest in expansion and cutting-edge equipment.

Together, Thrivory and Allied Infusion are paving the way for a more efficient and patient-centric future in MSO healthcare delivery.

What is Medical Receivables Financing?

Medical receivables financing, also known as medical accounts receivable financing or medical receivables factoring, is a financial solution that allows healthcare providers to receive immediate funding based on their outstanding medical claims. Instead of waiting for insurance companies or government payers to process and reimburse claims, providers can borrow against their receivables to access working capital.

Here’s a simplified breakdown of how it works:

• Healthcare providers submit claims to insurers or government payers for the services they’ve provided.
  

• Instead of waiting for reimbursement, the provider works with a medical receivables financing company that advances a percentage of the claim’s value, typically around 80%.
  

• Once the payer reimburses the claim, the financing company collects the balance minus a small fee.

This process enables healthcare providers to receive immediate cash, avoiding the lengthy delays that often accompany the medical billing process.

Why Medical Receivables Financing is Ideal for High-Ticket Claims

Providers who deal with high-ticket claims — such as those in specialty pharmacies, infusion centers, surgery centers, and other high-cost medical services — are particularly vulnerable to cash flow disruptions. The reasons for this include:

1. Complex Reimbursement Cycles: High-ticket medical services often involve multiple payers and complex billing codes. This increases the likelihood of errors or delays in processing claims. For example, infusion centers may need to coordinate with several insurers, pharmaceutical companies, and even government programs to receive full reimbursement.
   

2. Long Payment Delays: Insurance companies and government payers often take weeks or months to reimburse high-ticket claims. This delay can cause significant cash flow problems, especially for smaller practices that depend on timely payments to cover payroll, rent, and other operating expenses.
   

3. Higher Risk of Claim Denials: The larger and more complex a claim, the higher the risk of denials or requests for additional information. For instance, claims for specialty medications or surgeries may require pre-authorization or extra documentation, further slowing down the reimbursement process.

Medical receivables financing helps healthcare providers overcome these challenges by giving them immediate access to working capital, allowing them to maintain financial stability while waiting for claims to be processed. This is especially beneficial for practices dealing with high-ticket claims, where the delays and complexities of the reimbursement process can have a significant impact on cash flow.

Benefits of Medical Receivables Financing for High-Ticket Claims

For healthcare providers with large claim amounts, medical receivables financing offers several key benefits that can help improve financial health and operational efficiency:

1. Immediate Access to Capital

The most obvious benefit of medical receivables financing is the ability to access working capital without waiting for claim reimbursements. Providers can receive funding within days of submitting a claim, allowing them to cover operating expenses and invest in growth initiatives without the need for traditional loans or lines of credit.

For example, an infusion center that submits a high-ticket claim for an expensive specialty medication can receive 80% of the claim’s value immediatly, rather than waiting weeks or months for reimbursement. This immediate access to capital ensures the center can continue purchasing medications, paying staff, and providing high-quality care without interruptions.

2. Reduced Financial Risk

High-ticket claims can carry significant financial risk, particularly if there are delays or denials in the reimbursement process. By using medical receivables financing, healthcare providers can reduce their financial risk by securing guaranteed funding based on their receivables.

Unlike traditional financing options, medical receivables financing does not involve taking on additional debt or personal guarantees. The provider’s receivables serve as the collateral, and the financing company takes on the risk associated with reimbursement delays or denials. This allows providers to access capital without increasing their debt burden or putting personal assets at risk.

3. Improved Cash Flow

Cash flow is the lifeblood of any healthcare practice, and high-ticket claims can significantly disrupt the flow of cash if payments are delayed. Medical receivables financing allows providers to smooth out cash flow fluctuations by providing consistent, predictable funding based on their receivables.

This is particularly important for practices that depend on high-ticket claims for a large portion of their revenue. For example, a specialty pharmacy that regularly deals with claims for expensive medications can use medical receivables financing to ensure it has the working capital needed to purchase inventory and cover operating expenses while waiting for claims to be reimbursed.

4. Focus on Patient Care, Not Finances

Healthcare providers are in the business of providing care, not chasing down payments or managing cash flow. Medical receivables financing allows providers to focus on delivering high-quality care to their patients, rather than worrying about how to cover their next payroll or pay their suppliers.

By providing predictable, reliable funding, medical receivables financing reduces the financial stress associated with managing high-ticket claims. Providers can rest assured that they have the working capital needed to maintain operations and invest in growth, without the headaches that come with delayed reimbursements or claim denials.

Who Can Benefit from Medical Receivables Financing?

While any healthcare provider dealing with delayed reimbursements can benefit from medical receivables financing, it is particularly useful for practices that handle large claim amounts or complex billing processes. This includes:

• Specialty Pharmacies: Specialty pharmacies often deal with high-cost medications and complex reimbursement processes, making them ideal candidates for medical receivables financing.
  

• Infusion Centers: Infusion centers provide treatments that can cost thousands of dollars per session, making timely reimbursement essential for maintaining cash flow.
  

• Surgery Centers: Surgery centers frequently deal with high-ticket claims for surgeries and procedures, which can be delayed due to pre-authorization requirements or payer negotiations.
  

• Oncology Practices: Oncology treatments can involve expensive medications and complex billing codes, making it difficult to predict when claims will be reimbursed.

Conclusion: Thriving with Medical Receivables Financing

Managing high-ticket claims in the healthcare industry can be challenging, especially when dealing with complex reimbursement processes and delayed payments. However, medical receivables financing offers a solution that allows providers to access working capital quickly, reduce financial risk, and improve cash flow.

For healthcare providers like specialty pharmacies, infusion centers, and surgery centers, medical receivables financing is a key tool for maintaining financial stability while focusing on what matters most—delivering high-quality care to patients.

By partnering with Thrivory, healthcare practices can thrive with ease, knowing that their cash flow is secure and their financial risk is minimized.

Having access to working capital can ease these cash flow challenges. Here’s how:

1. Smooth Over Payment Delays

When patients are slow to meet their deductibles, your revenue can take a hit. With working capital in hand, you can cover immediate operational needs like payroll, utilities, and supplies—ensuring your practice runs smoothly, regardless of payment timing.

2. Maintain Focus on Patient Care

Without the constant worry about cash flow, you can prioritize what matters most: delivering quality care to your patients. Working capital allows you to keep your focus on patient outcomes, rather than chasing down payments or stressing over overhead costs.

3. Take Advantage of Growth Opportunities

Even during high-deductible season, growth shouldn’t take a backseat. Access to capital can help you invest in new equipment, expand services, or hire additional staff when the timing is right. It ensures you’re not missing out on opportunities simply due to fluctuating cash flow.

4. Stay Prepared for the Unexpected

Medical practices often encounter unexpected expenses, from equipment repairs to sudden staffing needs. With working capital in healthcare, you have a financial cushion to handle surprises, keeping your practice stable and agile, even during periods of payment uncertainty.

Access to Working Capital in Healthcare with Thrivory

At Thrivory, we understand the unique financial challenges your practice faces, especially during high-deductible season. That’s why we offer a streamlined solution to help you access capital quickly and without the complications of traditional financing. Unlike other funding options that involve debt, equity dilution, or asset risk, Thrivory provides a faster, more flexible way to improve your cash flow.

Our approval process takes just 3-5 days on average, and once approved, our platform delivers nearly instant access to funds through our “claims to cash” system. Importantly, Thrivory isn’t a traditional lender or MCA (merchant cash advance), meaning your practice’s assets aren’t at risk. We’re here to help you focus on what matters—growing your practice and providing excellent care.

In high-deductible season, the financial landscape can be challenging. But with the right working capital strategy, your practice can thrive through the peaks and valleys—keeping operations steady and your focus on what you do best: caring for your patients.

What is MCA Debt?

An MCA provides businesses with a lump sum of cash upfront, which is then repaid through a percentage of daily or weekly revenue. This structure can create unpredictable cash flow challenges for medical practices, particularly if patient or insurance payments are irregular or delayed. Unlike traditional loans, MCAs are structured as commercial transactions, which means they are not bound by the same regulations that govern loans, allowing for higher interest rates and less transparent terms.

Beyond the Upfront Cash: The Real Cost of MCAs

1. High Interest Rates: The costs associated with MCAs can be significantly higher than those of traditional loans. The annual percentage rate (APR) for MCAs can range from 40% to over 350%, making it an extremely costly way to borrow money.
   

2. Frequent Repayments: The repayment structure of MCAs can be a double-edged sword. While tying repayments to your average revenue may seem beneficial, the misalignment between deduction frequency (daily or weekly) and the actual timing of revenue receipt can create cash flow challenges, particularly if your income stream is unpredictable.
   

3. No Benefit from Early Repayment: Unlike traditional loans, where you can save on interest by paying off the debt early, MCA agreements typically require you to pay a fixed amount of fees and interest, regardless of when you pay it back.
   

4. Personal Guarantees: Many MCA agreements require personal guarantees from business owners, meaning that if the business fails to meet its repayment obligations, the owner’s personal assets could be at risk. This adds a significant layer of personal financial risk beyond the business’s liability.

The Cycle of Debt

One of the most insidious aspects of MCAs is the cycle of debt they often create. Medical practices, facing the initial burden of an MCA repayment, may find themselves short on cash once again, leading them to take out another MCA. This pattern can repeat, worsening the financial health of the practice, and in some cases, leading to a situation where the cost of debt service surpasses the practice’s incoming revenue.

Breaking Free with Better Alternatives

For medical practices caught in the MCA debt cycle or considering their options, there are more sustainable and supportive financing solutions available:

• Transparent Financing: Look for financial partners like Thrivory that offer clear, straightforward terms with no hidden fees. Understanding the full cost of financing upfront can save your practice from unexpected financial strain.
  

• Flexible Repayment Terms: Financing solutions that offer repayment terms aligned with your cash flow, such as debiting only once insurance reimbursements are received, can prevent the financial disruptions typical of MCA repayments.
  

• Off-Balance Sheet Financing: This type of financing does not add to your practice’s debt load, improving your financial standing and making your practice more attractive to investors.
  

• Long-term Partnerships: Choose a financing partner that supports your practice’s growth and optimizes your revenue cycle, addressing the root cause of slow-paying insurers rather than offering a temporary solution that leaves your practice vulnerable to future financial instability.

Conclusion

While MCAs might offer a quick fix, the long-term consequences can trap medical practices in a harmful cycle of debt. By exploring and choosing transparent, fair financing options, practices can maintain their financial health and focus on what truly matters—providing excellent care to their patients. Choose wisely, and take a step towards financial stability that supports your practice’s growth and success.