Knowledge Center

Reconsider Having your Collection Agency Send your 501r Final Notice

Shawn Gretz,
Ridiculously Nice Vice President of Sales

Over the past three years, I have had many conversations with not-for-profit hospital clients and potential clients who have asked Americollect to mail the 501r extraordinary collection action final notice on their behalf. Each and every time, I have steered them away from Americollect mailing this letter on their behalf due to liability concerns. Just last year, a court case gave me my “I’m so glad we didn’t do that!” moment for why a collection agency should not send this on your behalf.

Before we dive into the court case, here is a little background on two regulations:
501r: This regulation, governed by the IRS and part of the Affordable Care Act, requires not-for-profit hospitals to provide “financial assistance” to patients. The regulations spell out certain requirements to meet the IRS guidelines. More information on 501r can be viewed at:   One of the guidelines is, if a hospital chooses to do extraordinary collection actions (ECA), which is defined as credit bureau reporting, legal, or judicial actions against a patient, then the hospital has to mail a written (final) notice to give the patient a deadline after which the intended ECAs may be initiated. That deadline must be no earlier than 30 days after the date that the final notice is provided.

In addition, the regulations require the final notice to generally indicate that financial assistance is available for eligible individuals. Also, the final notice must list the intended ECAs the hospital facility may use.
FDCPA: The Fair Debt Collection Practices Act (FDCPA) is a regulation that collection agencies must follow. The FDCPA prohibits collection agencies from using “false, deceptive, or misleading representation[s] or means in connection with the collection of any debt.”

So how did these two regulations intertwine together for a court case? In 2016, Nina Flecha filed a class action suit under the FDCPA alleging that a collection agency (that will go unnamed and is NOT Americollect) mailed a final notice with a false threat to sue. Mrs. Flecha’s case is that Seton Medical Center does not allow legal action as part of their ECAs. The unnamed collection agency should have simply updated their final notice, removing legal action from the list of ECAs, and they likely would not have this class action suit filed against them. I believe that in the future there will be more cases in regards to another part of the FDCPA.

Part of the FDCPA says that collection agency communications have to take into account the “least sophisticated consumer.” This standard sets the bar for which communications can occur with patients. Consumer attorneys often sue collection agencies for language that could be confused by the “least sophisticated consumer,” and by having your collection agency mail your final notice. In a future newsletter article, we will address the “least sophisticated consumer” and why understanding this language is important to collecting; whether you are the hospital or a collection agency.

Oh by the way, this still doesn’t address the 501r requirement that, “the final notice must generally indicate that financial assistance is available for eligible individuals.” The conspicuous written notice requirements include that a “direct phone number and website address where applications, policies, and plain language summary” must be included. This is another place where a “least sophisticated consumer” could become confused.

Please, for the sake of your organization, don’t have the collection agency send your final notice as you never want the hospital’s name involved in a court case that could be avoided!

Reporting Pay Directs – Get it Right the First Time

Joelle Mark, Ridiculously Nice Compliance Officer

Americollect is working hard to change the way collection agencies are viewed, in a positive way!  We do this by being Ridiculously Nice and by partnering with our clients to make sure your accounts are accurate.

After an account is listed for bad debt, a patient may send the money directly to you, the medical provider.  If Americollect doesn’t know about the payment, we make calls and send letters to your patient. This may lead to the patient(s) becoming upset or confused and patient satisfaction scores may drop, file a complaint or even a lawsuit due to the collection agency attempting to collect a debt that is paid.  This is not only bad news for the collection agency, but, due to vicarious liability, it could also lead to a complaint or a lawsuit against the medical provider.

We want to do everything we can to ensure we have accurate information in our office as well as keeping our clients safe from complaints.  One of the steps we take to ensure accurate information is partnering with our clients to make it easier for them, too.  Here are some ways that Americollect can help:

Client Connect

  • Americollect offers an online portal for our clients to list, update and follow up on patient accounts. Our Ridiculously Nice Client Relations Department offers a detailed training session when access is requested for Client Connect.

System Access

  • By having access to our clients’ systems, we can do all of the work and make sure payments are reported correctly and timely. This also minimizes the need for us to call or email you for information.

Automated Payment and Adjustment Files

  • Most of our clients have electronic data files that are sent to us daily to automatically report and post any direct payments or adjustments made towards accounts. Please contact to get this started!

Reconciliation Files

  • Many of our clients send us a reconciliation file weekly or monthly. A reconciliation file is similar to an automated payment and adjustment file, but instead of just focusing on payments and adjustments, it focuses on making sure what we have listed in our office matches what is listed in our client’s office in every aspect.

If any of the above options are something that you have thought about, but did not know where to get started, give us a call and speak with our Ridiculously Nice Implementation Team. They will be able to help you decide which option would work best for you.

What data would be in an ideal payment and adjustment file: Your patient account number or visit number, the date it was listed for collection, the amount of the payment or adjustment, the date it was posted to your system and your balance after the payment or adjustment was posted.  The last item is wonderful to have on an “on-the-fly” reconciliation process.

In the year of 2017, we will be reaching out to our clients who do not have a systematic way to report payments and adjustment to develop a recurring process.  Let us help you improve patient satisfaction scores and prevent potential complaints and lawsuits. Please contact to get this started!


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A Healthy Serving of Patient Experience

Nick McLaughlin, Ridiculously Nice Sales

Not less than ten years ago we had to train our collectors for the common complaint from the patient of, “My insurance is supposed to pay 100%”, but for most American’s those days are long gone. The more likely complaint is now, “How am I going to come up with the $5,000 deductible.” This article is going to dig into the expected “patient experience” as a healthy serving of self-pay has been served up to you by insurance companies. Patients who have never dealt with a health system have an expectation that credit cards, cell phone, cable, utilities and other consumer service centers have created. Will you live up to the expectations and create a “better patient experience”?


There are more opportunities to screw up the best way to do statements than earn praise for doing a good job. If your statements follow the recommendations of HFMA’s Patient Friendly Billing Initiative, and you send the three monthly statements that 501r requires, you are on the right track. But before we move on from the subject of statements, let us begin the war on over-statementing. Did I just make up a word? Maybe! But you know what I mean. Occasionally, we still run into hospitals that send 5 or 6 statements to each patient before the account goes collections. This is a completely unnecessary waste of money. Almost as bad as that is when a hospital that has just converted to a new system sends their patients one statement for their accounts in the old system, and a separate statement for their accounts in the new system, and the new statement doesn’t include the accounts that are still due in the old system!

Imagine if your credit card company upgraded their system and began sending you two different bills, one for your charges before February 1, when they converted, and one for your charges after February 1… Their customers would be up in arms! The moral of the story is: combine your systems. 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. We specialize in combining multiple entities and systems into a better patient experience. It will help your patients lower their blood pressure, save you money, and prevent your patients from getting so frustrated they go to your competitor down the street.

Ridiculously Nice Calls

Making timely, friendly (we call Ridiculously Nice) follow up calls, and making them efficiently, is where a huge opportunity to improve the patient experience and cash flow lies.

We recommend starting outbound phone calls to patients 35 days after the initial statement is sent. We have found that calling patients before the first month is up, even in a Ridiculously Nice manner, creates awkward conversations, because patients expect to be given until their due date to pay the bill (normally a month later). Another great reason to start calling at day 35 is because the patient likely received their second statement 2-3 days ago, so it should be relatively fresh in their memory.

After the initial call, we recommend calling every 8 days, excluding weekends, until you get in touch with the patient. The 8 day interval causes you to call on a different day of the week each time, increasing the likelihood of a connection. Once the patient is reached, let the Customer Service Representative decide what the next best action is based on their conversation with the patient (payment-in-full, payment arrangement, try back next Friday because that’s payday, etc.)

I’ve heard some hospitals express concern that their staff might not be treating patients as well as they should on the phone. Call quality assurance is extremely important, which is why we use and recommend a tool called CallMiner. CallMiner monitors every single call for elevated tone, abusive language, right party contact, and many other helpful metrics. It alerts a supervisor if an issue comes up, allowing leadership to help right the situation.

Remember before when we discussed being compared to credit cards, cell phone, cable, and utilities? These markets have experience providing great customer service to keep customer satisfied. Two of the main metric they track in their call center are abandonment rates and/or average time to answer. These two metrics will tell you if your customer service team is providing a better patient experience. Abandonment rate should be under 5% and average time to answer should be under 20 seconds. If you are not meeting these marks, then it is time to ask yourself if you are frustrating your patients.

Payment Plans

Many hospitals leave money on the table by setting up a payment plan with a patient, and then never touching it again, even if it becomes delinquent. There are two very helpful times to reach out to a patient on a payment plan: when that patient has a new balance added to their total, and when that patient misses a payment or pays less than agreed. We set up programming that monitors all payment arrangements in our care, and queues a phone call to either increase the payment plan when a new balance comes in, or catch up on the payment plan if a payment is missed or underpaid.


We have seen phenomenal improvements in the efficiency and effectiveness of our Early Out/Self Pay service by implementing these best practices: statement consolidation, follow up calls every 8 days starting at day 35, CallMiner for call quality assurance, and calling patients when they miss/underpay a payment plan or a new balance is added to their total. We hope you can capitalize on what we’ve learned by either implementing these practices in your billing office, or calling us to see if we can help you in that area!

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501r Help is Here!

Shawn Gretz, Ridiculously Nice Vice President of Sales

I hate doing my taxes. First, there is the waiting to receive my W-2, 1099, 1095, and 10-4. The last one isn’t real, but you know what I mean. Then there is the gathering all the taxes documents together and either calling a CPA and waiting a month for an appointment or working with TurboTax to complete your taxes by yourself. The entire process is time-consuming and tedious. The same can be said about 501r. The connection here is that IRS is behind both pains. Well, if you are experiencing pain with 501r, Americollect is here to help.

If you have found the IRS “oral notification” or “final notice” process tedious or time-consuming for your staff to complete, then let Americollect use our dialing technology and relationship with statement provider to send them on your behalf. Here is the painless process:

  1. Transfer File: Transfer a simple file with the patient demographic information to Americollect with all account balances ready for an oral notification or final notice.
  2. There is no two. The rest we will handle.

This takes a 30-minute setup call with Americollect to ask a few simple questions such as:

  1. What number should patients be sent to if they have questions about financial assistance?
  2. What “Extraordinary Collection Actions” do you perform?
  3. Can I have a copy of your plain language summary?
  4. Can you email me a copy of your logo?

For more information about how Americollect can make 501r “oral notification” or “final notice” painless call Shawn at 920-420-3420 or email For any other questions about 501r, please call or email Shawn above or visit our website at

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To view our recorded webinars on 501r, click here.

Reference Based BULLY-ing

Shawn Gretz, Ridiculously Nice Vice 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

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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

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“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

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