At MainStreet, many patients pay via text before the provider can mail a bill

MainStreet Family Care serves patients in primarily rural areas throughout Alabama, Georgia, Florida and North Carolina. For many of these patients, MainStreet is their only local option for care.


In fact, for many patients, MainStreet’s urgent care providers fill gaps in primary care, such as assistance with managing chronic conditions, to help keep people from becoming sick. Without these centers, patients would have to travel to meet with a specialist – often for long distances.

But it takes funding to provide these services, said Drew Smith, director, revenue cycle, at MainStreet Family Care.

“That means we’re dependent on people to pay their out-of-pocket costs of care,” he noted. “We’re also reliant on patients to pay their bills in a timely manner to lower our costs to collect. Sending paper statements costs $6 per statement, not just because of paper and postage costs, but also due to the manual labor required to post physical checks and the need for a lockbox.

“And, because the communities we serve are very tight knit, we need to avoid sending accounts to collections as much as possible so we can maintain a feeling of trust between our facility and our residents,” he added.

MainStreet wanted to find new ways to communicate patient financial responsibility and meet individuals where they are so they would better understand their bill and their options for payment. The faster the provider organization is able to collect that revenue, the quicker and easier it is to open a new clinic in a high-needs area, which promotes better health.


“By leaning into text-based payments, we could more effectively reach patients through the device they use most: their phone,” Smith stated. “A Pew Research Center survey found 97% of American adults own a cell phone. Even in rural areas, 80% of residents use a smartphone, compared with 71% before the pandemic – and those numbers continue to climb.

“I recommend waiting a week for consumers to engage with SMS-based communications before mailing a print statement. This reduces the costs of paper-based statements and manual labor while allowing staff to spend time on more value-added work.”

Drew Smith, MainStreet Family Care

“It’s also a lot easier to obtain a correct phone number rather than a fully correct address, which saves administrative time and cost, such as the cost of dealing with returned mail,” he continued. “We believed we could communicate with patients faster and easier regarding their financial responsibility for care using a preferred tool for communication.”

Just as important is the potential to speed payment with SMS-based patient payment technology, he added.

“A recent survey by AccessOne shows 40% of consumers rank secure text among their top two preferred options for patient financial communications,” he said. “Nearly half say they pay their medical bills in six days or less when text is offered as an option for payment. We believed we could increase convenience and decrease days in accounts receivable by leveraging an SMS-based approach.”


MainStreet Family Care rolled out a mobile pay option from AccessOne in 2019. Patients receive a text as soon as their account is ready to view. MainStreet only gets charged for the text-based communications that are successfully delivered by its mobile pay vendor. If MainStreet doesn’t have a good mobile number for a patient, it doesn’t get charged for that attempt.

“The system integrates with our patient portal so the most accurate out-of-pocket amount is conveyed to patients,” Smith explained. “This amount factors in the portion we expect insurance to pay. In addition, the texts are branded with our organization’s look and feel so patients know the communications they are getting are from our facility.

“There was some skepticism around how patients in our rural communities would respond to receiving a text requesting payment,” he noted. “We worked to remove the element of surprise by educating our team on why text-based payment is important, how it works and what to expect. These team members then served as ambassadors for our system, helping residents feel more comfortable with our text-to-payment feature.”

MainStreet created scripting for staff that helps keep messaging crisp and clear. During registration, staff double check that smartphone notifications are sent to the patient’s preferred phone number to help ease patients’ level of comfort with this approach.

“We also opted to wait five days before a paper statement is sent to patients’ homes to give the text notifications a chance to work, with the goal of reducing our statement costs,” Smith said.


Today at MainStreet, nearly 15% of patient payments are paid through the mobile pay system, and 95% of accounts paid via secure text are paid within 14 days.

Even better: More than 80% of that bucket is paid before a paper statement is even printed. This has reduced paper statement volume by 11%. It also has decreased manual work for the patient accounts team by five hours per week, or 260 hours per year.

“Mobile payment also has turned our call center into a better-performing channel,” Smith reported. “When patients have a question about the information they receive by text, they can call us using the phone number displayed on the payment screen.

“Most of the patients who call us end up making a payment by phone or updating their insurance information with us so we can adjust their out-of-pocket estimate,” he continued. “This has increased efficiency while creating a better financial experience for patients.”


“It’s important to communicate to patients that a change like this is coming, whether through communications before and after the point of care, posters or fliers in waiting rooms, or messaging on your website,” Smith advised.

“This removes the element of surprise from SMS-based communications around payment,” he continued. “It also increases the likelihood that individuals will open the text and make a payment.”

Creating scripting for staff to use when introducing a new payment vehicle also is key, he added. This helps staff feel more comfortable initiating conversations while keeping messaging crisp and clear, he said.

“We’ve also gained a lot of value from giving digital communications time to breathe,” he noted. “I recommend waiting a week for consumers to engage with SMS-based communications before mailing a print statement. This reduces the costs of paper-based statements and manual labor while allowing staff to spend time on more value-added work.”

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