Healthcare Receivables Financing
Healthcare receivables are not ordinary B2B invoices. Payment comes from government payers, insurers, and patients, often after coding, authorization, and sometimes denial cycles. A conventional ABL or invoice factoring provider that advances on 30-day commercial invoices will treat a large share of that book as ineligible. Specialty financing facilities are built around how those claims actually collect.
Terms and facility size sit on the Specialty Finance page.
How This File Is Underwritten
The lender underwrites the receivable engine, including payer mix, billing quality, and how claims collect.
- Payer mix: Medicare, Medicaid, commercial insurance, and self-pay do not collect the same way or at the same speed.
- Billing quality: Clean claims, denial rates, days in A/R, and who owns the billing work.
- Eligibility: Aged claims, unsettled denials, unbilled encounters, related-party accounts, and amounts in appeal often come out of the base. Headline A/R is not availability.
- Concentration: One facility, one physician, one payer, or one billing TIN can cap the line.
- Operations: License, enrollment, and continuity of the practice matter because the receivable dies if billing stops.
No-Fault and PIP Claims
PIP and other statutory auto medical claims, including New York no-fault, are healthcare receivables. A book that is mostly no-fault is assessed on how those claims bill and collect, which is not the same schedule as in-network commercial or Medicare AR. Aged claims, related-party accounts, and amounts in appeal sometimes come out of the base, as they do on the rest of the healthcare book.
What Usually Binds
- Eligible, collectible claims after payer and aging cuts
- Days in A/R and denial rates
- Payer and facility concentration
- Unbilled or unenrolled activity
- Company cash flow, reviewed but not the primary sizing test
What To Send First
- A/R aging by payer class (Medicare, Medicaid, commercial, self-pay, and no-fault/PIP if material)
- Denial and days-in-A/R summary
- Trailing collections vs billings
- Last year-end financials and current interim
- Debt schedule
- Locations, specialties, in-house vs outsourced billing
- Enrollment / payer-contract snapshot
- Bank statements
When This Is The Wrong Product
Commercial invoices to businesses belong on invoice factoring or ABL. Cash-pay practices with no payer file will not support this line. Clinic equipment or owner-occupied real estate is equipment financing or SBA, not a receivables facility.
FAQs
Is this factoring or a line?
Either structure exists in this vertical. Eligibility and collections matter more than the label.
Do patient balances count?
Usually little, sometimes not at all. Payer claims are the asset.
We use an outside biller. Is that a problem?
No, if reporting is complete and the relationship is stable. Yes, if no one can produce a payer-level aging.