Patient Payment Seasonality 2.0: Projecting Cash Flow Down to the Day

If we’ve learned anything about patient payments, it’s that there are a lot of forces at play: inflation, Medicaid disenrollments, system outages, even the occasional TikTok influencer.

At times, they can feel random, completely outside anyone’s control—nothing like the insurance claims providers track with military precision.

But that doesn’t mean there aren’t patterns. Patterns that, when understood, give revenue cycle leaders a powerful way to anticipate what’s ahead and see how this year stacks up against last.

We’ve previously written about our seasonality index, which maps the expected monthly distribution of patient payments. Our latest analysis drills down to daily trends, offering even sharper insights for the rest of 2025 and beyond.

Disclaimer: Patient payment seasonality is subject to change based not only external events, but also operational changes, technology deployments, held claims, and other factors.

A quick primer on seasonality

At its core, patient payment seasonality reflects when patients receive bills and have both the motivation and means to pay them.

It’s why health systems and physician groups typically see the strongest collections in March, with momentum continuing through the second quarter. Deductible resets, higher billing volumes, and tax refunds converge to drive this spike in the first half.

2023 Patient Payments Across Cedar Clients:
Monthly Percentage of Annual Collections ¹

The practical application is straightforward: use each month’s historical share of annual payments to project current-year collections. For example, if you’ve collected $10 million through June and the first half typically represents 54% of annual collections, you could see roughly $18 million for the year.

Pro Tips:

• Choose your reference year carefully. Organizations that relied on Change Healthcare in 2024, for instance, likely saw claim processing delays due to the outage. They might want to look to 2023 when projecting cash flow for 2025.
  
• Beyond external factors, watch payment plan uptake. Higher adoption this year can shift the timing of payments, changing expected patterns.

Taking seasonality one step further

Monthly seasonal patterns give revenue cycle leaders a novel way to project patient collections. But what if we could get more precise?

We found that even within the same month year-over-year, performance can shift meaningfully based on how the calendar falls. Why? Because weekdays consistently generate significantly more collections than weekends. Peak weekdays like Monday (18% of weekly collections on average) are double Saturday’s contribution (9%).

2024 Patient Payments Across Cedar Clients
Daily Percentage of Weekly Collections ²

Putting this into practice, let’s compare September 2024 and September 2025 for a large health system. This year’s September has one fewer Sunday and one more Tuesday. Using last year’s actual daily percentage of monthly collections for this organization, we see that September 2025 can potentially bring in 1.5% more cash purely due to calendar differences.

September 2024 (Actual) vs. 2025 (Projected) Patient Payments for One Health System: Daily Percentage of Monthly Collections ³

Bottom line

Patient payments will always be unpredictable. But with seasonality baked into your toolkit, you can swap reaction for foresight.

That means projecting cash flow with confidence, setting realistic expectations with leadership, and making smarter operational decisions. More importantly, it gives your team the clarity to focus on the levers that actually move the needle—whether that’s engagement strategies, financial assistance programs, or workflow optimizations—rather than chasing predictable dips and spikes.

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Meg Ricks is an Associate, Value Analytics at Cedar

1. Cedar. (2023). Average monthly distribution of annual patient collections across Cedar clients. ↩︎
2. Cedar. (2024). Average daily distribution of weekly patient collections across selected Cedar clients. ↩︎
3. Cedar. (2024). Actual daily distribution of monthly patient collections in September 2024 vs. projected daily distribution of monthly patient collections in September 2025 at a large health system. ↩︎