If after reasonable collection efforts a balance remains uncollectible, how is it typically handled?

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When a balance can’t be collected after you’ve done everything reasonable to collect it, you treat it as bad debt. In medical billing terms, you pursue the patient with statements and calls, and possibly use a collection agency. If it becomes clear that no future collection is likely, you write the amount off as bad debt, which reduces accounts receivable and records an expense (or draws on an existing allowance for doubtful accounts if you maintain one). This reflects that you no longer expect to collect that money.

Charitable care is different: it’s a deliberate waiver of charges for patients who can’t pay, recorded as charity care expense rather than as a bad debt. Revenue adjustments and fee adjustments are used to reflect contract discounts, payer negotiations, or patient discounts, not to write off amounts deemed uncollectible.