Reference Based BULLY-ing

Shawn Gretz, Ridiculously Nice President of Sales

A letter or EOB arrives at your facility from the bully that states: Accepting and depositing the previously sent payment means the Provider “agreed that such payment constitutes an accord and satisfaction and will take precedence over any previous terms,” or “we demand that the hospital cease and desist all collection activity against the beneficiary and demand that the hospital appeals the determination through the Plan’s internal dispute resolution process.”

As any person being bullied knows, and as Freud has written, there are two options: 1. Fight or 2. Flight.

Background: Since the 1980’s, the basic approach employers have used to control healthcare costs has been through Preferred Provider Organizations (PPO) that negotiate discounts off the gross/billed charges. This is considered “top down” negotiating. “Top down” negotiating leaves room for a hospital to overstate the gross costs for a procedure leaving the insurance company paying a lot more than the actual cost of a procedure. Enter in self-funded groups who want to work the way Medicare does with “bottom up” pricing as a means to control costs. Medicare establishes a base rate for each service and then makes adjustments based upon patient complications, geographic location differences, and other factors to determine the maximum amount they will pay a hospital for a procedure.

Self-funded/employer-sponsored health plans would prefer to work the way Medicare does by using “bottom up” pricing or what is termed Reference Based Billing. They are electing not to enter into a contract with hospitals and have no provider network or one that is very limited. A patient is free to choose any hospital they wish to have the procedure done, which patients appreciate versus being told which facility they must visit because it is in-network. These plans want to limit the payment for the hospital services provided to the patient by “Re-Pricing” the service at a “bottom-up” amount. Many benefit consulting firms are telling these health plans that they can state their “bottom-up” price. They create what is called an “allowable claim limit.” “Allowable claim limits” for inpatient are based upon a percentage of Medicare reimbursement or cost as reported to Medicare on the most recent cost report.  Generally, this is 120%-150% of Medicare costs or other published data. Some reference based pricing models are only doing this for specific procedures such as appendectomy or knee-replacements.

After the service was provided to the patient, a hospital usually receives payment on an EOB stating that by depositing this payment the hospital is agreeing to accept the “bottom-up” pricing and the amount should be considered payment-in-full minus any co-payments, co-insurance, or deductibles that the patient may owe. The idea is that reference based bullies want you to think that you cannot balance bill the patient. This is the “flight” that these self-funded/employer sponsored health plans are hoping you choose.

But Can You “Fight” or Balance Bill the Patient?

The answer is usually YES, but be ready to deal with legal counsel from the self-funded/employer sponsored group to start the bullying. Before we get into how you can defend your “fight” or balance billing the patient, let’s talk about the offense and defense to fight this bullying. As any sports fan has heard “the best offense is a great defense.”

 Defense Tactic #1: Admissions and Registration need to be on the lookout for insurance cards that read:

“We restrict hospital charges to the amount the Plan deems reasonable and states that by accepting an assignment of benefits from the beneficiary, a hospital waives any right to recover payment more than the Plan determined Allowable Claim Limit.” Or something to that nature. If a registration person receives an insurance card that reads this, they need to go on offense.

Offensive Tactic #1: Start with a discussion with the patient immediately that although the hospital will bill the insurance for the services, they do not agree to the terms of this insurance card. Create a form letter that the insurance card can be scanned into that creates an admission agreement that states: XYZ hospital does not agree to the terms of this insurance card, and the patient understands that the patient’s insurance is out-of-network. Any charges including deductibles, co-insurance, copays, along with charges that are not contractually agreed to will be balanced billed to the patient. The patient agrees that they will pay for any balance-billed charges. Then ask the patient to sign the agreement.

Offensive Tactic #2: Immediately call the self-funded/employer sponsored plan and notify them that the patient agreed to the admissions agreement that they will be “balanced billing the patient” for any charges for an “out-of-network” admissions. Any further communications that attempts to prevent this billing will be considered a “tortious interference” with my business relationship with the patient. We would gladly welcome the opportunity to discuss a potential contract with your plan by calling XXX.

Defensive Tactic #2: After receiving a letter or EOB as mentioned above with the language of cease and desist all collection activity” or “accord and satisfaction” it is time to start sending letters to the plan and also the patient. This letter should contain language that the hospital does not agree to the terms the EOB or letter states because of no contractual agreement between the plan; and therefore, will follow our policies of balance billing the patient for the remaining charges along with any deductible, co-insurance, and co-payment. If the Offensive Tactic #1 was completed, mail this along with this letter and continue billing the patient.

Offensive Tactic #3: Call the patient to ensure that the legal counsel does not represent the patient interest and document that this question were asked of the patient. “I am calling to see if you have any legal representation. If you do not, we will continue to communicate with you.”

Offensive Tactic #4: As these plans start to appear more frequently at your facility, then it is time to assign a billing representative to oversee responses. This includes having conversations with the plan administrator and working out an arrangement or contract that is agreeable to all parties. Sometimes the best tactic is to negotiate.

Offensive Tactic #5: Update your billing and collection policy to include strong language for those contracts that are out-of-network. My suggestion for this language would be:

It is the patient’s responsibility to present at the time of admission, registration, pre-authorization or discharged any third-party-payer available to pay for services. XYZ will attempt to bill all third party payers for services provided. The patient is responsible for ensuring that XYZ and all doctors performing services are within network. If XYZ is out-of-network with the third party payer, the patient will be responsible for out-of-network charges including coinsurance, co-payments, deductibles, and also additional balances for being out-of-network that will be balanced billed to the patient. XYZ does not participate with the out-of-network reference based billing plans.

If all these offenses and defensive tactics fail, Americollect is here to help. Our legal team of professionals will communicate with the plan and the patient to ensure the account is paid-in-full. If you have any questions in-regards to reference based bullies, please call or email Shawn at 920-420-3420 or

To read the full newsletter, click here.

To view our recorded webinar on Medicare Bad Debt, click here.

Pentatonix…I Mean, Hallelujah Penetration Test

By: Kenlyn T. Gretz, Ridiculously Nice President and CEO

An email arrives in your inbox with an attachment. It is from a partner that your healthcare organization does business with.  The attachment is generically named “report.xlsx” with the subject line “Your Request” and it is signed by Jeff Barker from, Warner Health Care Solutions.  You think to yourself, “Hmmm, I think we used a company named Warner a few years back.  Is this something our CFO informed me I would be getting an email on?   Should I open the attachment?  Should I reply to the email?”

October was Cybersecurity month and the more you are aware, the better!  The saying at Americollect is “think before you click” and we train our team on the importance. The email described above is often the start of a ransomware encryption engine that starts encrypting your documents and files in all of your healthcare computer file directories. Then a “hacker” will ask for money. This has been in the news recently and is occurring to healthcare systems around the United States. The FBI’s response has been, “Just pay the ransomed.”

The attachment discussed above had an embedded .exe file which runs when the attachment is opened. It may not display a “I Got You!”  The “report.xlsx” file may simply be blank, you close it down and delete email.  “Oh Good, nothing bad happened” – but it did. In the background the ransomware is spreading through your system encrypting every document it can find in every folder!  Five hours later, your IT Department calls you and asks, “Did you open an email that was suspicious earlier today?”

In January of 2016, Americollect received a 470 question document from the State of Massachusetts asking us about our security controls. As our IT started working through the questions, we realized we could “tighten” our security even more. So we started with the Duo Authentication for Citrix logins (Duo authentication for Citrix logins), sophisticated intrusion detection systems, stronger web filers, more complex password requirements, phishing testing, co-worker cyber security training and penetration test on internal, and external network access points. Additional resources were spent on this, because I would rather spend it on increasing our cybersecurity than paying some ransomware pirate or super expensive cybersecurity insurance.

We have had a few clients ask us about cyber insurance. Cyber insurance pays for the cost of notifying consumers if there is a data breach.  In my mind, this is too late, the damage is done.  It is kind of like preventive healthcare. Wouldn’t you rather spend money on getting healthy versus spending money on being ill? Require your vendors to prove their security with audits and certifications. This is where the money should be spent, protecting.

We hired an outside penetration test firm from Tampa, Florida named KirkpatrickPrice. KirkpatrickPrice has years of experience in this field and did a thorough job. They have “white hats” who, for simple terms, try to “break-in” to your networks. They also try to access as if they are already inside the network (co-workers) and try to break in to areas they don’t have access to. Our Network Administrator, Alex Hartlaub, explains that “white hats” are hackers for the good guys. Alex worked with the team to administrate the test and to review areas of improvement once the test was completed.  After thorough examination, we had a report which showed 11 areas of improvement.

In all cases, the “white hats” were not able to access any data.  The 11 areas of improvement were resolved within two weeks! We plan to continue to do the penetration tests to make sure we are ahead of all of the “hackers” who are continuously trying new things. Our client’s data is too important to risk a breach or hacking.

Take cybersecurity issues, hacking, data breach, and ransomware seriously and staying ahead of the attacks. Double check, even triple check, with your vendors to ensure they are doing everything possible to keep your patients information secure!

Eight Years As a “Best Places to Work in Collections

Kenlyn (smaller)

By: Kenlyn T. Gretz, Ridiculously Nice CEO
“Culture Eats Strategy for Breakfast” was a quote made famous by legendary IBM leader Peter Drucker. Americollect also believes in a strong culture. That culture has allowed us to be named as one of the Best Places to Work in Collections for the 8th consecutive year! The eight consecutive years is a feat that has not been done by any other organization. Oh, by the way, we also have grown in placements by 690% since being first named to the list and all this time only losing one hospital as a client. Enough with patting ourselves on our back and onto what matters most to you. How does Americollect create a culture to allow us to win this award for eight consecutive years?
Below are some of our attributes that we feel have allowed us to get to where we are today:
1. Together we Can – Americollect will work as a team. More like a professional sport in a small market then a kid’s recreational team. This means Americollect will attempt to hire to develop talent. Americollect will have the best players playing and replace those not performing. Americollect will create competition for positions. Americollect will show loyalty to our players.
2. Coach – Americollect will coach players on how to perform. All players will receive coaching regardless of your seniority or role. All players will be expected to learn new talents or refresh old talents throughout the year. All players are expected to play the role of “coach” to others.
3. Flexible – Americollect will provide a flexible work-life culture. Americollect respects the juggling act of life and will provide flextime to spend with family or other life issues within the guidelines that are set.
4. Stir-The-Pot – Americollect does not believe gossip is good for the organization and will remove players for “stirring the pot.”
5. Only See Good – Americollect believes in seeing the good in all that we encounter.
6. Eye-Level Service – Americollect believes in providing Eye-Level Service. Eye-Level comes from the carpentry world where perfection is demanded at the level that the client sees. “Clients” range from Americollect’s clients to co-workers, to regulators, and last but not least patients. We demand perfection in these areas.
7. Bringing Value to Those We Encounter – Americollect believes in doing more than we get paid for to make an investment in our future. We encourage our team to anticipate the needs of our “clients.” We encourage our team to provide education to our “clients.”
8. Growth – Americollect believes in growth and development. Americollect supports self-growth through experience, observation, introspection, reading, and discussion. Americollect believes in challenging ourselves to become more than what we currently are.
9. Technology – Americollect embraces and believes that technology can improve the lives of our “clients.”
10. 75% People – 25% Metrics – Americollect understands that culture matters more that metrics but metrics deserves attention as well.
11. Communication – Americollect believes in intentionally communicating with all of our team members. This includes monthly all team member meetings to the mundane daily communications to our team members. We will intentionally communicate to ensure we are all on the same page.
12. Celebration – Americollect will celebrate our successes and life changing moments for the company and team members.

For more information on the Best Places to work in collections visit Inside ARM, click here

To read our full newsletter, click here

“Nice” List

ShawnBy: Shawn Gretz – Ridiculously Nice VP of Sales

“He’s making a list, and checking it twice, gonna find out who’s naughty and NICE”…. Many of you may have just sang along with me in your head. The funny thing is I’m guessing you didn’t know that I was talking about your patients. With the increase in using social rating systems online and HCAPS; patients are checking up on you to make sure “Nice” is something your facility offers from the time the patient enters your facility all the way through self-pay follow-up. “Nice” is about accomplishing one of the dimensions of the Institute for Healthcare Improvement Triple Aim approach for a better patient experience. So will you be making the “Nice” list in 2017?

I want to help increase the number that make the “Nice” list in 2017. Here are three items I believe AmeriE.B.O. can help with:
1. Consolidated Patient Friendly Statements and Patient Friendly Reminder Calls – Patients are screaming for one experience whether they visit your doctor’s office, hospital, or ambulatory surgery center. If your name is on the door, then one consolidated patient friendly statement and payment plan should be established for the patient. AmeriE.B.O specializes in combining multiple entities and systems into a better patient experience.
 2. Better Patient Communications – “Your call is very important to us and it will be answered by the next available agent” or “hello healthcare business office.” These are two of my biggest pet-peeves when I call a hospital business office. It is obvious to the patient that their call isn’t important enough to be staffed correctly to handle the volume of inbound calls coming into your facility or for that matter by the name of the facility that I am calling. AmeriE.B.O. offers better patient communications by working with our clients to set the expectations of wait times and abandonment call volumes to ensure a better patient experience.
3. Adding Balances to Payment Plans – Healthcare is different in that multiple dates of service continue to add balances to the amount a patient owes. If healthcare were like a credit card, a patient would receive a statement with the minimum amount owed each month. But should healthcare take this approach? AmeriE.B.O. monitors payment plans. If a new date of service is added to the balance we communicate with patients either on their statement or with a call; to increase the payment plan to ensure the balances are paid off promptly. This proactive communication provides a better patient experience.

I want to help increase the number that make the “Nice” list in 2017. Here are three items I believe Americollect can help with:
1. Healthcare Training – Americollect exclusively collects for healthcare clients. This provides Americollect the ability to train our collectors on healthcare only. This training allows collectors to explain away the complexity of healthcare and help the patient understand the difference between a co-pay and deductible and how much adjustments were made on the account to leave the remaining balance as self-pay. A better-trained collector provides a better patient experience.
2. Industry Knowledge – Americollect pride ourselves on bringing value to all our clients and potential clients. We work hard to stay up on the latest information on 501r, Medicare bad debt, and presumptively qualifying patients for financial assistance. By being a leader in these topics, it allows Americollect to ensure accounts are placed in the right bucket to not only help our client collect more money but also provide a better patient experience.
3. Happier Collectors – Eight years in a row, Americollect has been named as one of the best places to work in collections. We engage our team members with our unique team culture to help drive the results. We always say, “happier collectors, collect more money while providing a better patient experience.”

“Nice” doesn’t end when the patient leaves your campus. “Nice” should continue to self-pay follow-up and also to collections. Come join Americollect and Ameri E.B.O. and have your patients put you on the “Nice” list in 2017! Happy Holidays to you and yours!

IRS is Already Reviewing 501r and Scheduling Field Examinations

ShawnBy: Shawn Gretz – Ridiculously Nice VP of Sales

Yes, you heard that right, the IRS has already started to do field examinations for 501r. Just under 25% of the not-for-profit hospitals in the United States were reviewed and 166 hospitals were scheduled for field examinations. Are you ready for a review or for that matter a field examinations if you fail the review?
The first question that you may be asking yourself is “how did the hospital that was reviewed get determined to be field examined?” The article described the lack of a “community health needs assessment, financial assistance, and/or emergency medical care policy or necessary billing and collection policy.” I assume the IRS did this review from their desks in Washington D.C. Meaning they just searched your website for the 501r requirement of being widely publicized.

How to pass the widely publicized review if you are behind on 501r:

Step 1: Ensure a webpage is dedicated the community health needs assessment and financial assistance.

Step 2: Ensure the Financial Assistance page include the following documents: A. Financial Assistance Policy; B. Plain Language Summary; C. Financial Assistance Application; and D. Billing and Collection Policy. Also make sure these documents are translated based on 5% of the population or 1,000 individuals, whichever is less likely to be affected or encountered by the hospital. May use “any reasonable method to determine such populations” and can use either U.S. Census Bureau or American Community Survey data. If there are fewer than 50 persons in a language group that reaches the 5-percent trigger, the recipient of federal financial assistance does not have to translate vital written materials to satisfy the safe harbor but may provide written notice in the primary language of the limited English proficiency (LEP) language group of the right to receive competent oral interpretation of those written materials, free of cost.

Step 3: I would suggest that the updated the financial assistance web page with the same information that is on the plain language summary: A. A simple explanation of how a patient can qualify for financial assistance; B. Phone number for where a patient can receive assistance with financial assistance; and C. Location in the hospital where a patient can receive assistance.

Oh by the way, this review isn’t going away. The IRS must review, at least once every three years, the community benefit activities of about 3,000 tax-exempt hospitals, according to the ACA. Much of this information was gather from the Bloomberg article released on October 5th, 2016 titled: “IRS ACA Compliance Checks Give Nonprofit Hospitals ‘Nudge’.”
If you would like more checklists, sample billing and collection policies, or just a helping hand with 501r, please visit: or call or email Shawn Gretz at or 920-420-3420.

To read the full edition of Americollect’s Fall Advisor Newsletter, click here

501r “Reasonable Efforts” Newsletter

501r – 4 “Reasonable Efforts”

By: Shawn Gretz, VP of Sales and Marketing

501r Reasonable EffortsThis newsletter is dedicated to the four “reasonable efforts” requirements  released in 501r  (501r is an IRS regulation released in 2014 with  requirements for all not-for-profit 501c3 hospitals).  In this newsletter we are going to dive into the requirements for 501r’s reasonable efforts and how many facilities are accomplishing these “reasonable efforts”.

4 Reasonable Efforts:  

  1.  At Least Three Statement: Send billing statements with conspicuous written notice about financial assistance.
  2.  Plain Language Summary: Mail a plain language summary with only one post-discharge communication.
  3.  Final Notice – Written notice to state a deadline after which the identified ECA(s) (extraordinary collection actions) may be initiated.
  4.  Oral Notification – Orally notify patients about financial assistance at least 30 days before ECAs.

These “reasonable efforts” are to be spelled out in the billing and collection policy as well as the timeline for usage by the health system.

This article will go into detail on how to accomplish the reasonable efforts.

Americollect is offering FREE Financial Assistance and Billing and Collection policy reviews. To take advantage of these free reviews, just email your policies to

 Read the full Newsletter here


Advisor Newsletter – Special Release – 501(r)

501(r) – Checklist, Policy Samples, and More!
by Shawn Gretz – VP of Sales

Welcome to the wonderful world of regulation. This entire expanded newsletter is dedicated to 501(r)! 501(r) is a complex set of requirements that I like to call HIPAA 2.0 because of the amount of work to implement 501(r) and maintain compliance will be similar to HIPAA. I would highly recommend you start TODAY! Regardless of what the IRS believes (see below), this regulation will take thousands of hours to implement and teach.

For complete articles and checklists, click this link to read more:
Checklists, & Policies

Evaluating Collection Agencies

By: Joe Maretti, Ridiculously Nice Collection Sales

As patient Joe Maretti Pro Pix LG-emaildeductibles and self-pay responsibility continue to grow, it is becoming more important to work with a collection agency who can drive more money to your revenue cycle while maintaining excellent customer service on both the patient and customer side. Knowing how to evaluate collection agency performance is a rare tool that will serve your group well. Here are some tools to use to ensure you have the best collection agency partner for your practice:

1) How to Test A New Collection Agency: You have used one collection agency for a long time and think an industry leader could come in and collect more for your group. How can you test the new agency without jumping in with both feet in case it doesn’t work out? The best way to learn about what else is out there is to try it with an alpha-split of your accounts. Comparing recovery statistics of accounts placed after the competition began will give you the best idea of which agency is better. Give the two agencies twelve months to show which is more effective and at the end of the term, grant the agency that out performed the other 100% of placements going forward. The champion agency will know that there is a chance that the group will use this process in the future as part of their checks and balances and will be sure to perform at a high level so as not to jeopardize the business. So what recovery statistic should be used in comparing agencies? This leads us to the next tool.

2) The Netback Formula: The best statistic to use when considering collection agency performance is Netback. Netback = (total dollars collected – commission paid)/total dollars placed with the agency. It gives true cash recovery as a percentage and can be used to compare performance of multiple collection agencies regardless of differences in dollars placed and commission the agencies may charge. For example: if a radiology group places $1 million with Agency A who charges 25%, $2 million with Agency B who charges 23%, Agency A collects $150,000 and Agency B collects $290,000, who did a better job?
• Agency A’s Netback Percentage is 11.25%(($150,000-$37,500)/$1,000,000)
• Agency B’s Netback Percentage is 11.17%(($290,000-$66,700)/$2,000,000).
Agency A is the winner, even though they collected less total money and charged a higher fee. I would rather have 11.25% of $3 million than 11.17% of $2 million and 11.25% of $1 million. The difference is almost $2,000! Work with an agency that can deliver a higher netback percentage and your practice will be more profitable. If you feel that your netback is low and your agency’s fees are too high, it might be time to look at a change.

3) Bang for Your Buck: A common question we get is, “Am I paying too much commission to my current agency?” The answer is often, “Yes,” and sometimes “You’re paying too little.” Here’s why:
Too high: The most common cause of a group paying too much commission is that they’ve been with the same collection agency for over 10 years. A lot has changed for us collection agencies in the last decade or two. Technology especially. We are able to contact far more patients in far less time using predictive dialers and voicemail detection tools. The cost savings has been significant and collection agencies have been able to pass some of that savings on to clients. If you have a great, long-term relationship with your collection agency, and your commission structure hasn’t been updated in awhile, ask for a reduction to at least the mid-20%’s. If they’ve kept up with modern technology, they should have no problem granting that to you.
Too little: On the flip side, working with an agency with a low fee structure isn’t always good for the group. At some point, too low of a fee structure means fewer work events and less money collected for the group; a lower netback. Sometimes paying a better agency a higher percentage will get you more in return. Keep that in mind next time you evaluate.

Next time you are looking to add or replace one of your self-pay or collection agencies, make sure you are looking at more than just commission rate and liquidation percentages. Although these are very important factors in deciding which collection partner is right, it’s important to look deeper to make sure you are getting the most value out of your agency.

Radiology Specific Collection Strategies That Increase Revenue

By: Nick McLaughlin, CHFP 
Ridiculously Nice Collection Sales

Communication and confusion are the two biggest challenges in terms of collecting patient Nickbalances in radiology. Employing collection agencies who use the strategies laid out in this article will overcome these challenges and greatly increase bad debt recovery and profit for your practice.

Challenge #1:
Communication – Communication is particularly challenging for radiology accounts because of the high incidence of small balance accounts. It is easy to justify calling a patient with a $1,000 account to try to collect. The 5-7 minutes an average right party contact call takes could yield $1,000 for the provider and between $200 and $250 for the collection agency. It’s far more difficult to justify getting on the phone with a person who owes $10. The potential yield of that call could be just $2 to $2.50.

Solution: Reduce the Cost per Call – Reducing the cost of making a call allows agencies to make more of them and ultimately recover more for their clients. Employing state of the art predictive dialer technology is one piece of that puzzle. Americollect increased call efficiency by 30% by upgrading to our Sytel predictive dialer in 2014. In order to get the most out of the technology, there needs to be a large number (50 or more) of collectors on a single dialing queue at the same time. The dialer capitalizes on the law of large numbers to work through even more accounts per collector hour.
Voicemail Detection is the next tool that reduces cost per call. Once a collector verifies the right number from a patient’s voicemail message, they can activate the dialer’s Voicemail Detection function. This way, on future calls that go to an answering machine, a message recorded by one of our Collectors is left in the patient’s voicemail automatically, saving almost one minute of collector time per call that goes to voicemail.

Solution: Call at the Best Time – The other key to cost-effective communication is calling at the right time. Most of us have a similar schedule from one day to the next. Whether that means working 9am-5pm or 3pm-11pm, or running kids to school and other activities, we are often away from home at the same times each day. No answer memory is a tool that helps agencies call people when they are more likely to be available. It remembers when a call is not answered and then blocks out an hour before and an hour after the call was made. The next call goes out during a different time of day. Additionally, it remembers when right party contact is made and sends future calls out during that hour of the day.
Another tool that helps reach patients at the right time is called Triggers. Triggers is a credit bureau tool that helps target contact attempts after the first few months of work have been unsuccessful. It notifies agencies if a patient improves their credit score, pays on other debt, or applies for new credit. The best time to collect from a patient is when they have a creditor telling them they need to take care of their other accounts before they’ll loan them money. This tool also gives contact information from any new credit application which increases the likelihood of successful contact and payment.

Challenge #2:
Confusion –Many of your patients don’t understand why they received a small bill from a doctor group they have never heard of. They aren’t even sure that they owe this bill. And what do many of them do after they receive your bill? They think to themselves, “I don’t have time right now to make this phone call, so I’ll put it in my to-do pile and get to it later when I have the time.” Next thing they know, its a few months down the road and their telephone rings. It’s a collection agency calling because they haven’t paid their radiology bill yet. Why haven’t they paid? Because they still don’t understand what they owe. It may be their fault for not getting to it yet, but that’s another issue entirely!

Solution: Treat Them Ridiculously Nice – Our job is to help them overcome their confusion. This is where Ridiculously Nice Collections comes into play here at Americollect. We help patients calmly approach the issue at hand, help them ask the questions they have so they know their bill is legitimate, and help them feel comfortable working with us to resolve their account.

Solution: Radiology Expertise – Expertise in collecting, specifically for radiology group, is extremely helpful as well. Collectors have to know the nuances of hospital-based radiology in order to overcome a patient’s confusion. A normal collector without this knowledge would say, “This bill is from July 10, 2015 when you saw ABC Radiology.” The patient knows they never went to ABC Radiology, so the call must be wrong or a scam. If ABC Radiology uses a collection agency with collectors that know how to explain their accounts, the call will sound like this: “This bill is from July 10, 2015 when you went to ABC Hospital. Your physician must have run a few tests while you were there and ABC Radiology is the physician group that read your tests.” The patient knows they did go to ABC Hospital in July and probably had some tests run. Connecting these dots while talking with someone friendly brings them from confusion to understanding; a place where they feel comfortable paying this bill in full.

Hiring a collection agency with the right combination of technology, friendliness, and expertise will help both your top-line revenue to the practice, as well as patient satisfaction. Look for these tools and attributes next time you review your current collection agency partner or look for a new one.

Cell Phones and Your Liability:

TelephoKGretzpicturene Consumer Protection Act (TCPA) Recent Declaratory Ruling    Kenlyn T. Gretz, President & CEO

The Telephone Consumer Protection Act, which was originally enacted in 1991, was revised by the Federal Communications Commission(FCC) in June 2015 and is disappointing and very detrimental to you. The nuts and bolts of the law prevents calls to cells phones using an “auto dialer” unless express permission is received. The violation is between $500 and $1500 for each phone attempt. Every method of auto dialing is covered, no matter what you call it: Robocalls, auto dialing, messaging, cloud dialing, predictive dialing, and attended dialing. You can call a patient with a pre-recorded message or an auto dialer as long as you have written or oral express permission. You must stop making auto dialed calls to cell phones if the patient asks you to. Yes, your appointment and test result reminders are also covered under this law. This is not just about collection calls.
The FCC was prompted to make this declaratory ruling after receiving dozens of petitions on behalf of multiple organizations. The healthcare industry trade group American Association of Healthcare Administrative Management (AAHAM) and our very own Shawn Gretz. VP of Sales, lobbied Congressman and Senators for an update. AAHAM was one of the many petitions that the FCC addressed. The result of these petitions was a procedural move by the FCC called a “declaratory ruling”. What the procedural move removes the opportunity for any comments made on the ruling before it is released. By not allowing comments, the FCC took away our rights to make suggestions before a final regulation was implemented. Several industries, including the ACA International, have filed law suits against the FCC for this ruling and procedural move. We hope to find the right solutions to TCPA that prevents commercial robocalls but also does not pad the pockets of those suing legitimate companies.
What do you, the medical provider, need to do?

Contracts with Patients:
You need to add language to your admission and consent to treat agreements that could help protect you from lawsuits. According to the FCC the burden of proof, when the patient gave you a phone number, it is your burden. This is the number one thing you must to do. Later this year, we are going to ask for a copy of your agreement. For the clients who have not added this language in their agreement, we are going to either stop collecting for you or increase your commission rate due to a greater risk for law suits both of us. Updating your website’s patient portal legal disclaimer to also include this language is also highly recommended. If you need assistance in writing this language for your contract/website, please contact our compliance department, whose contact information is at the end of the article.
Note documentation:
When a patient gives you their cell phone number as a point of contact, if you have a field in your system that is labeled cell, then please put that phone number in that location and get that phone number to your business associates and subcontractors. It is okay to autodial them when the patient gives you a phone number. It is okay for one medical provider to pass that express permission of a cell phone to vendors, other covered entities, and business associates related to that patient and medical treatment. Your agreement should state that you have this right. If you have call recording capabilities, you may want to consider saving your call recordings for four years as this is the statute of limitations for the TCPA. Many times the call recording has the proof that the patient gave your company that phone number when they became a patient.
Report Change of Phone Numbers: Let your vendors know if the patient gives you a new phone number so they can stop calling the old phone number. You may also want to document, in the notes, the date a patient gives you a new or different phone number to call. Per Mary, her new phone number is 920-555-1212. There is an easy solution to help you notify your vendors. Please contact our compliance department for that solution. The FCC has stated it is the caller’s responsibility to make sure they are not calling wrong numbers. This is a burden that is easy to fail.
Re-Assigned Numbers: A re-assigned number is a phone number that you have given up and now somebody else owns. The patient usually doesn’t inform you they gave up the phone number. The FCC says, if you call a patient and the phone number has been re-assigned, if they do not answer the phone, this is your “constructive knowledge” that the phone number has been re-assigned. Callers get one free call as a “safe harbor” and then you are liable under the TCPA. If you make a second call to a “wrong number,” the patient can sue you. The FCC acknowledges that there is no good method to determine if the phone number is now re-assigned. There are a few databases out there that give the owner of a cell phone, but they self admit they are 60%-70% accurate and up-to- date. This “get out of free” phone call includes both you as a client and us as your business associate. We, together, only get one phone call to that re-assigned phone number.
Typo’s: If your team is off by one digit and you call a “wrong party” the FCC says you get one free call! Then you are liable under the TCPA. Again, they say you are under “constructive knowledge” if the patient doesn’t answer the phone.
Educate Patient Access and Scheduling: You need to get patient access to learn more about the TCPA and their responsibilities of cell phones, change of phone numbers, and proper documentation. Early Fall, Americollect will be hosting a webinar: Understanding the TCPA for Healthcare Providers with Direct Patient Contact. If you would like attend this webinar or would like to be notified of future webinars, please email
Do not allow skip tracing: Stop looking for phone numbers on the internet, i.e. Facebook, LinkedIn and so on. You do not have express permission to use those phone numbers. The only way you can get express permission is directly from the patient and you should be asking the patient with every visit. If your health system has a vendor that verifies the patient’s identity, demographics, insurance eligibility, or gives you a score, DO NOT USE those phone numbers they provide to you. You do not have express permission to auto dial that number. You can manually dial it, but do not put it in the phone locations in your system or in the notes. It is too easy for somebody else to move that number to the phone data field.
Report “Do not call me any more” to your vendors: If a patient tells you “Do not call me at this number”, have a policy where you get that information documented to your system and then communicate with your vendors. Americollect has been seeing consumers slipping this into their “copy & paste” dispute letters.
Revoking Cell Phone Calls: The FCC has stated it is illegal for you to require your patients to revoke their rights in a specific manner to be auto dialed. A simple statement that would say: “If you no longer want us to auto dial your phone number, please email or call 800-xxx-yyyy” is an illegal obligation you are attempting to put on your patients. The FCC says that a patient can revoke their right at anytime in any method. If the doctor is in the middle of a procedure and the patient revokes his phone number for calling, you need to make sure your doctor relays that information to your system.
And now for the GOOD NEWS:
There is none! Well, there is but it requires some jumping through hoops!
Copy of Entire FCC Order
If you have additional questions, please call or email us at: Americollect Compliance: 800-838-0100 or