Knowledge Center

Proposed FPL Changes and the Impact to Financial Assistance

Proposed changes to the Federal Poverty Level (FPL)Joseph Maretti, Ridiculously Nice Sales

The Trump Administration has proposed updating the way in which the Federal Poverty Level (FPL) is measured. The formula that currently determines someone’s poverty level has been around since the Social Security Administration created Medicare in 1965. The way Americans have spent their disposable income, along with inflation, has changed considerably since then. One could argue that it’s time to adjust this formula to be more in line with today’s current inflation measures.

Today, the U.S. Census Bureau looks at the poverty threshold and factors in inflation to provide an update on how many Americans are living in poverty every year. The Department of Health and Human Services (DHHS) issues poverty guidelines based on the number of individuals for each household. For example, the poverty level for a household of four is an annual income of $25,750. To get the poverty level for larger families, simply add $4,420 for each additional person in the household. For smaller families, subtract $4,420 per person. Guidelines for Alaska and Hawaii are higher due to cost of living. DHHS then bases their poverty guidelines around this threshold to determine an individual’s eligibility for certain benefits. Under the current proposal, the Office of Management and Budget would adopt a lower rate of inflation to determine the poverty threshold. This means fewer people would qualify for certain benefits as the poverty threshold would rise more gradually over time.

How could this impact your facility?

Should this proposal go through, it could mean a significant number of individuals who currently qualify for the financial assistance benefit would no longer be eligible. To help paint a clearer picture, the Center on Budget and Policy Priorities (CBPP), a left-leaning think tank, released a report this month examining the 10-year impact of the proposal:

  • More than 250,000 seniors or people with disabilities could either lose their eligibility for Medicare Part D’s low-income subsidy program or receive less assistance from it.
  • More than 150,000 seniors or people with disabilities could lose assistance with their Medicare premiums.
  • More than 300,000 children could lose Medicaid and CHIP coverage.
  • More than 250,000 people could lose the coverage they gained through the Affordable Care Act’s Medicaid expansion.
  • More than 150,000 ACA exchange enrollees could lose some or all of their cost-sharing assistance.
  • Tens of thousands of ACA enrollees could lose their premium subsidies, along with millions who receive smaller subsidies.

According to the Congressional Budget Office (CBO), estimates indicate that the yearly cut across federal health coverage programs would total in the billions of dollars by the tenth year. The impact on program eligibility thresholds would roughly double between the tenth and twentieth year; should the policy go into effect.

In the event the administration is successful, it may be likely that alternative measures will be created to determine the poverty level for social programs at the State level, so as not to rely on the federal poverty line.

Many hospitals rely heavily on the revenue that is generated through these federal programs for their indigent patient population, so it’s important to keep this proposed legislation on your radar. Americollect will continue to monitor this situation as it unfolds and watch for any updates or changes to the proposed regulation.

Shawn Gretz Appointed to HFMA National Advisory Council Revenue Cycle Committee

Shawn Gretz, President of Americollect, has been appointed to the Healthcare Financial Management Association (HFMA) National Advisory Council (NAC) Revenue Cycle Committee beginning June 1, 2020. In his two-year appointment, Shawn will join the 23 members of the NAC to focus on key issues facing the healthcare industry and HFMA.

Shawn has been an HFMA volunteer since 2006 in various roles and capacities, including president of the Wisconsin chapter and a member of the Regional Executive team for Region 7 (Illinois, Wisconsin and Indiana). During this time, he has had many accomplishments, and his dedication to HFMA has led to his appointment to the NAC Revenue Cycle Committee.

“I’m excited to join the NAC Revenue Cycle Committee to learn about the pain points that are impacting the industry from a revenue cycle standpoint,” said Shawn. “I look forward to bringing my experience from ridiculously nice self-pay and bad debt collections to the committee to help improve the patient experience in healthcare.”

The NAC provides professional perspective on thought leadership topics important to HFMA members. Council appointments are made from individuals who are active in their profession as well as HFMA volunteers who are knowledgeable in their respective areas.

Americollect firmly believes that everyone deserves to be treated Ridiculously Nice, all the time, no matter what. Collecting only for the healthcare industry, we utilize our Ridiculously Nice approach to open communication lines and build trust with the patient, providing the same compassionate approach that they expect from their healthcare organizations. We partner with over 130 hospitals and health systems and over 7,000 physicians to collect more money than our competition while creating an unparalleled patient experience.  



Can you wait to be paid?

It would be pretty sweet to be able to buy a new car and not pay for it, right? Or to just walk in and buy groceries without opening your wallet. But how long would the auto manufacturers or grocery stores stay in business if they had to wait years to get paid? Not very long. But that’s exactly what is happening in the healthcare industry.

It seems like every few years someone in congress decides to “help” protect consumers against rising medical costs. Sure, they mean well, but Rep. Rashida Tlaib, a Democrat from Michigan, doesn’t understand the ripple effect a bill like H.R. 5330 would have.

H.R. 5330, also known as the Consumer Protection for Medical Debt Collections Act, is a bill “to amend the Fair Debt Collection Practices Act to provide a timetable for verification of medical debt and to increase the efficiency of credit markets with more perfect information, to prohibit consumer reporting agencies from issuing consumer reports containing information about debts related to medically necessary procedure, about and for other purposes.”

But what does that really mean? It means that consumers would have up to TWO YEARS before it impacts their credit, an extremely long time compared to what is currently allowed. Plus, the legislation would delay the ability to report medical debt to credit reporting agencies for one year, and it would ban the reporting of debt arising out of “medically necessary procedures,” which would be the majority of accounts sent to collections.

And while some believe this would help consumers, it would just kick the can a little further down the road. Consumers have several options when it comes to dealing with their medical expenses – including charity care – and agencies are often the ones to educate them on these choices. If Congress takes away our ability to communicate with consumers in a timely manner, it only pushes that obligation off and adds to an uncertain financial future with a smaller window for resolution, and even less chance of recovery.

Join us in letting our U.S. Representatives know how this would impact the entire healthcare world by calling or emailing your Representative TODAY.


What You Need to Know About the New Robocall Act

There’s a sound that strikes fear in the hearts of many Americans. An incessant noise that we dread.

The ringing of our phone – for a robocall.

As we use our phones for email, text and other messaging systems more and more, fewer people call each other, but that sure hasn’t stopped unscrupulous individuals from picking up the slack, trying everything from offering “free” vacations and reducing debt to hawking medical devices they swear your doctor is paying for.

In 2019, more than 58.5 billion robocalls were made in the United States, which means over 178 calls were made to the average American. That’s a lot of calls you don’t want to answer!

Just before the new year, President Trump signed into law the Pallone-Thune TRACED (Telephone Robocall Abuse Criminal Enforcement and Deterrence) Act, an important step in the fight against these illegal robocalls. And while this act won’t instantly stop all those calls from coming in, it will help the FCC and law enforcement go after scammers with increased penalties and push major wireless carriers and home phone providers to do more to stop the incessant calls.

More importantly, it will give consumers something even better than a quieter phone. It will give them the confidence to know that the calls coming to their phones are actually meant for them, which means more answered calls, and in the legitimate collection’s world, more right party contacts and more debt recovery for you.

At Americollect, we’ve been following this Act since it was initially announced and are excited about the impact it will have not only for us, but for hospitals and healthcare providers across the country. There are several elements that we see having an impact on unwanted robocalls, including:

  • Telecommunications providers must implement STIR/SHAKEN (Secure Telephony Identity Revisited and Secure Handling of Asserted information using toKENs), which uses digital certificates based on common public key cryptography techniques to ensure the calling number of a telephone call is secure. Simply put, each telephone service provider obtains their digital certificate from an authority who is trusted by other telephone service providers.
  • The implementation of a comprehensive caller ID authentication program designed to let people know whether or not the caller ID displayed on incoming calls is accurate. This also includes a validated “name portion” of the caller ID, which, if you have a cell phone, it currently shows only the number and the city/state.
  • The FCC is required to ensure that consumers who receive telephone service from smaller or rural providers benefit from an authentication service.
  • Telephone providers are prohibited from billing separately for either the authentication or blocking services.
  • The FCC must initiate a proceeding to evaluate how to require voice providers that provide multiple phone numbers to callers (like Skype and Google Voice) know their customers. (This will stop robocallers from cycling through numerous numbers to avoid detection.)
  • Enhanced FCC enforcement mechanisms.
  • Establishing working groups and reports from the FCC.
  • The FCC has to allow providers to employ a “robocall blocking” methodology for unauthenticated calls.

The concern with the last bullet for legitimate calling businesses is ensuring that they are not blocked by accident. Imagine your entire health system being unable to connect on any outbound calls because the telecommunications provider determined you were a “robocaller” simply for calling with appointment reminders.

To help ensure that Americollect numbers are verified as authentic, we have partnered with a leader in the field of unique identity resolution. They monitor to safeguard our numbers from being listed as spam or robocalls when we’re making outbound calls, increasing the confidence that the right name is displayed on caller ID when we call.

In addition to utilizing what the TRACED Act will provide, Americollect is taking additional steps to ensure that we are able to connect with your patients through a variety of means, including the Reassigned Number Database.

The Reassigned Number Database is a single comprehensive database that will contain information related to disconnected numbers so a caller can determine whether a number has been permanently disconnected – and reassigned – prior to making a call. Once the Reassigned Number Database goes live in mid to late 2020, we will be able to take additional steps to certify the numbers we are calling have not been reassigned before we call. It is important that healthcare providers develop a process within their system to note the date they received the phone number from the patient and the last time it was verified. 

The new omnichannel solution we are working on, which is an advanced communication platform, will allow us to seamlessly ping the Reassigned Number Database quickly and succinctly, ensuring that we are able to continue making contact at our regular rate without missing a beat. Our omnichannel solution means near real-time action, something other agencies may be unable to provide.

Americollect uses email to communicate with patients on an opt-in basis, however a recent proposal by the Consumer Financial Protection Bureau (CFPB) is providing legal clarity for the use of email, which only strengthens our omnichannel solution. According to, 86-percent of patients still receive paper medical bills. When you look at the number of people who receive their bank, credit card, cell phone and other statements via email, there is a lot of potential for this communication channel.

Once the CFPB moves forward with clarifying the rules for email communication, we will be able to work with patients who don’t have confidence in their phone to have confidence in their email, knowing that the communication they receive from us is real. You can help your collection agency prepare for this by sharing verified patient email addresses you have on file, so they have multiple ways to contact the consumer.

Not only will the TRACED Act help agencies like Americollect reach patients, it will also help hospitals battle incoming robocalls. The Hospital Robocall Protection Group is being created to assist hospitals by issuing a “best practices” to how hospitals can better combat unlawful robocalls made to hospitals, how they can better protect themselves from such calls and how the Federal and State governments can help combat such calls.

We are excited about how the TRACED Act will positively impact unwanted robocalls, making it easier for patients to confidently know the calls they are receiving are real, not spam calls that we all dislike.

We are even more excited to be able to answer our phones and not be offered a “free” trip or medical device that we don’t need!


It’s My Birthday and All I Got Was This Surprise Medical Bill

Nick Mclaughlin, Ridiculously Nice Sales

Yes indeed, it was my birthday this week! I didn’t actually receive a surprise medical bill for my birthday (thank goodness!), but there sure is a lot of buzz on the topic in Washington D.C.! With the increase in high-deductible health plans in America, patients are feeling the financial impact of their healthcare services more directly than ever.

What exactly is a “surprise medical bill,” and why is it a problem?
Proposed surprise medical bill legislation specifically addresses the conundrum of in-network and out-of-network healthcare providers. For example, if you visit the Emergency Department of a hospital that is in your insurance plan’s network, yet the physicians group that staffs the ED is out-of-network, the patient would receive a surprise medical bill. Many hospitals use out-of-network consulting services such as radiology and pathology. If a patient utilizes a hospital with outsourced services, they could end up receiving a surprise medical bill, even though the hospital they visited was in-network. Another such situation resulting in a surprise medical bill would be using an out-of-network ambulance, regardless if it is air or ground transportation.Situations such as these, along with the increase in high-deductible health plans, results in a rise in liens on homes, bank accounts and taxes, garnished wages, and crippling medical debt. The Kaiser Family Foundation completed a national poll of partisans, asking whether or not the federal government should protect patients from balance billing for out-of-network services. The results of this poll shows that 90% of Democrats, 77% of Independents and even 61% of Republicans said “Yes.”

A new bipartisan proposal would remove patients from disputes between insurance companies, doctors and hospitals. This act would require that health insurers pay at least the median in-network market rate for the area. For bills that are above $750, either side could seek to have an independent arbitrator resolve the conflict if they disagree with the benchmark rate. This act is the marriage of the first two solutions below.

Possible Solution Number #1 – Regulate Out-Of-Network Payment (“Burn in Hell”)
The first possible solution to reducing surprise medical bills comes out of the Senate. Senators Bill Cassidy (R-LA) and Maggie Hassan (D-NH) offer a two-fold proposal: step one – prohibit balance billing, and step two – regulate out-of-network payment. The plan seems relatively simple at first glance, but big questions remain about how prices would be set. Would the payment standard be a percentage of Medicare reimbursement? Or a percentage of average in-network payments?

This is similar to a plan some health plans are enacting called “reference-based pricing.” It’s a simpler solution compared to others that have been proposed, but it significantly reduces the ability for providers and insurance companies to negotiate contracted rates. A large health system in North Carolina decided not to participate in such a health plan that capped provider payments at 160% of the Medicare rate for inpatient care and 230% of the Medicare rate for outpatient services. An administrator from the system sent an email to the health plan that read, “Burn in hell, you sorry SOBs,” further stating that the plan “would financially destroy every hospital in this state.” Mandating a program like this for out-of-network payment would likely distort some of the market forces left in healthcare.

Possible Solution Number #2 – Baseball-Style Arbitration
The second possible solution to reduce out-of-network pricing comes out of the House. Representatives Frank Pallone (D-NJ) and Greg Walden (R-OR) offer a similar restriction against balance billing, but include baseball-style arbitration for determining what the payment should be. In Major League Baseball, most young players with less than three years of major league “service time” earn the league minimum salary. However, once they reach three years, they become eligible for salary arbitration. The team submits a salary offer, the player submits a salary offer, and a third-party arbiter decides which salary is the fairest; no compromise.

Balance billing patients would still be prohibited, but arbitration would not be between the patient and the provider each time a service is rendered, but instead with the insurance company and provider for a set period. The biggest questions around this solution are who would set the guidelines for arbiters, and what should those guidelines be? It does maintain market forces to an extent, but administratively, a system like this is very burdensome.

Non-Legislative Possible Solution – In-Network Matching Guarantee
Another possibility is for hospitals to voluntarily offer an in-network matching guarantee. This means that any doctor or clinician who treats a patient at an in-network hospital would have to accept the patient’s in-network payment rate. It seems like a nice way for hospitals to differentiate themselves from neighboring hospitals to increase market share, but could discourage physician groups to practice at their hospitals.

Who Wants What?
Once again, the money fight in healthcare is between insurers, hospitals and clinicians. Insurers want federal payment standards to be set, which would likely lower reimbursement benchmarks for setting contracted prices. Providers, for the most part, prefer the arbitration style approach to settling payment disputes, since it would make the process to challenge their out-of-network rates more difficult. Limiting out-of-network payment rates could significantly distort the importance of contracting between insurers and providers. A hospital threatening to leave an insurer’s network gives them leverage to negotiate higher payment rates, and an insurer threatening to leave a provider out of their network gives insurers more leverage to negotiate lower payment rates. How surprise medical bill legislation impacts this dynamic will be interesting to follow in the coming years. We will continue to keep an eye on this issue to see where it goes.

501r Questions and Answers

Shawn Gretz, President

Our charity program offers a partial discount or full write-off based on the current Federal Poverty Guidelines. If a patient is approved for partial charity, are we required to reactivate the account (cancel with the agency) and restart the billing cycle based on the new balance?

Not necessarily, but you do have to send an approval letter with a 30-day notification to pay the remaining account balance in full before collection actions can begin again.

When a patient applies for financial assistance and the account has already been submitted to our outside collection agency, does 501(r) require us to retract the account from the agency while the account is pending review for financial assistance?

No. You do not need to retract the account but you should notify the collection agency and ask them to put the account on hold. For instance with Epic, we normally use billing indicators to automatically notify us of accounts that are put in financial assistance work queues. If approved, we receive a different billing indicator notifying us of approval and we wait for the balance change in the adjustment/withdrawal file. If denied, we normally get a different billing indicator. Unless your policy reads differently, then you will have to retract while pending.

Our current process is that once notified of the passing of the patient, the spouse will then become responsible for the outstanding balance and our communication is targeted toward the spouse and collection processes. When we make the spouse become responsible for the charges, per 501(r) rules, do we need to reset the aging to allow for 120 days to pass before sending to collections?     

I would suggest you define who the “responsible party” is in the financial assistance policy. By defining who is in the billing and collection policy, it will allow the “reasonable efforts” period to continue without starting over. For example, a responsible party is defined as all individuals who live together, married, and/or by state law, are required to pay for services regardless of whose name is used for initial correspondence.

We bill some outpatient (retail) pharmacy. Is this a required charge to be eligible for charity care and to refund if qualified, under 501 regulations? If we do include it, would we need to follow 501(r) guidelines and refund any amount going back 240 days including these charges if the patient already paid?

Yes, you can exclude this and many do. The IRS allows you to exclude any services you wish, but this requires an update of your policy. This is especially the case if the pharmacy falls under the same Tax ID or reports up to the same financials of the 501(c)(3) hospital or health system.

Does a physician list that includes generic practice names such as Chiropractor, Orthodontics, Dentist, Plastic Surgery, and Optometry meet the 501(r) requirements?             

Technically, no, this doesn’t meet the requirements. In a follow-up to the final regulations, the IRS specified that the actual names of the physician practices like “XYZ Radiologists. LTD” should be spelled out. Also, a hospital facility should update its list of providers by adding new or missing information, correcting erroneous information, and deleting obsolete information at least quarterly. Make sure you take reasonable steps to ensure that the list is accurate. The good news is if you forgot about this, it is considered a minor mistake that doesn’t have to be reported, just corrected.

Right now we have a financial assistance policy posted for each of our affiliates/critical access hospitals.  The intent is that each of the policies are the same as our master policy.  Is there any reason that we need a separate policy for each one?  Can we just indicate in the master policy which locations it applies to and then have a separate board approval page for each location attached to the policy?

Yes, you can have one master agreement for all hospitals in a health system. The only stipulation is that you need to use the most generous AGB for all hospitals. Finally, the final regulation allows the board to specify an individual or committee to approve the financial assistance policies on behalf of the hospital. Because the ability to have all hospital boards approving the same policy is cumbersome, I would suggest instead to create a committee assigned by the board at each hospital to take up approval processes and relieve some of the additional work of the board. This will also make it easier on the Revenue Cycle team!

Does the 501(r) Compliance apply to clinic and hospital services?

Yes and No.

1. It depends upon the tax reporting of the hospital. If the clinic is its own entity and doesn’t report up through the hospital financials, then it could be considered a disregarded entity and the answer would be no. If the clinic reports up through the hospital’s financials then the answer is yes. Check with your CFO or

Controller to make sure.

2. You could always just add the clinic as part of your exclusion lists in your financial assistance policy and then the answer is No.

Americollect Highlights their Culture of “Giving” to Celebrate 55 Year Anniversary

The year 2019 marks a milestone for Americollect as they celebrate 55 years of bringing their Ridiculously Nice concept to clients, consumers and the community.

For their 55th anniversary, Americollect decided to highlight their unique culture of fun and giving back to others by presenting employees with a Random Acts of Kindness challenge. Team members are working towards a goal of 550 RAK’s (Random Acts of Kindness) by the end of the year. These RAK’s happen within the walls of Americollect, as well as throughout the community. Americollect team members have already completed more than 125 RAK’s.

“It never ceases to amaze me how considerate and giving our team members are. I hear stories of team members providing transportation to fellow coworkers to ensure they get to work when their car breaks down. We have many individuals lending a hand at grocery stores by assisting others with their grocery bill when they fall a little short or helping elderly individuals get their groceries out to their cars and loaded up. Other team members have purchased food and drinks for others while in fast food lines. Our coworkers are working together to basically do whatever they can to show what Ridiculously Nice really means to us. We have a great team here and I am so proud to look around at all the work everyone is doing to celebrate our 55 years,” stated Kenlyn T. Gretz, CEO of Americollect.

In addition to their RAK’s, Americollect is also raffling $55 to a lucky employee every week and working towards completing 55 5K/10K races by the end of the year. Kenlyn stated, “We thrive on a fun culture here at Americollect and we want to carry out that culture in how we celebrate our 55 years.”

Americollect partners with healthcare systems nationwide, operating two divisions: one serving as a hospital’s customer service team, and the other as a healthcare collection agency. Our team provides a better patient experience by being Ridiculously Nice. 

Price Transparency Turbo Booster – Are You Ready?

Nick McLaughlin

Regional Director of Ridiculously Nice Sales at Americollect

As the rule stands today, hospitals are required to provide patients with a list of their standard charges at the patient’s request. This nudge toward healthcare consumerism and price transparency opened the age of patient responsibility estimates, but has not achieved the level of “shopping” for lower cost healthcare services that CMS wanted to see. Enter the price transparency turbo booster – 2019 IPPS/LTCH PPS final rule. Starting January 1, 2019, all hospitals will be required to post that same list of standard charges on the Internet in a machine-readable format.

Patient Challenges According to the CMS FAQs regarding this issue, the requirement applies to all items and all services provided by the hospital. One of the biggest challenges regarding this issue is that the list is to be pulled from the retail chargemaster, which does not reflect the amounts hospitals are actually reimbursed for their services. The published prices will be even further from the amounts patients should expect to pay out of pocket. Hopefully this possible confusion about how much a service will actually cost patients won’t cause them to postpone care and allow health issues to get worse.

Potential Hospital Solutions I see more vendors each year offering patient responsibility estimates, and if that isn’t something that your hospital has decided to implement, now may well be the time. One of the best responses to someone calling in to complain about how high your prices that they found on the Internet would be, “Well, Nick, what is the service that you are looking for?” How much a service is going to cost them is far more important to them than arguing that your retail chargemaster prices seem higher than your neighboring hospitals’. Teaching your front line staff to have these conversations in a Ridiculously Nice way, in order to help patients get the information that they are truly looking for, will pay great dividends with patient loyalty in the future.

Are you ready?

Government Hospital Organizations and Consequences of 501(r) Non-Compliance

Nick McLaughlin

Regional Director of Ridiculously Nice Sales at Americollect

Many government hospital organizations were told they were off the 501(r) hook in 2016. New guidance from the IRS significantly narrows that loophole, and one unnamed county hospital has already had it’s 501(c)(3) status revoked. In the redacted tax status letter to the hospital, IRS officials stated that the hospital’s failures were “egregious,” and that “the organization’s administrators made it clear that [the hospital] had neither the will, the financial resources, nor the staff to follow through with (501(r) requirements”. Loss of the 501(c)(3) exemption eliminates a hospital’s ability to use certain employee benefit plans, subjects hospitals to income, property, and other taxes, disallows receipt of tax-deductible contributions, and bars use of tax-exempt bonds.

For those unfamiliar, 501(r) requires hospitals to standardize billing and collection policies, conduct Community Health Needs Assessments (CHNAs), respond to the needs found in the CHNA, and proactively notify patients of the availability of financial assistance – all in order to justify tax-exempt status. According to the IRS clarification, unless your hospital is not recognized as tax-exempt under Section 501(c)(3), you are required to comply with the 501(r) regulations.

One common question has been, “What if I don’t have to file a Form 990?” There are a handful of hospitals that are excused from filing a Form 990 under Revenue Procedure 95-48 and the Affordable Care Act did not change the requirements regarding which organizations are required to file a Form 990. That said, the IRS made it clear that in order to be treated as described in section 501(c)(3), “government hospital organizations still must meet all section 501(r) requirements that do not involve disclosure on or with the Form 990, including making their Community Health Needs Assessment reports and Financial Assistance Policies widely available on a website.”

So, if you’re saying to yourself right now, “Well, I guess we have to do this thing but where do I start?” We are here to help! Our team has helped hospitals across the U.S. get up to speed with 501(r) absolutely free. Our only ask is that the next time you’re looking for a new Early Out or Bad Debt partner, you give us a chance to show you the difference Ridiculously Nice can make! On our website,, you will find an entire bootcamp regarding 501(r) compliant Financial Assistance and Billing and Collection Policies, what you need to add to your current Collection Agency Agreements for 501(r) compliance, as well as how to comply with the “Reasonable Efforts” and “Widely Publicized” requirements. Also available there are recorded webinars that cover Financial Assistance Policy requirements as well as the regulations around Extraordinary Collection Actions. The resources are extensive, helpful, and we encourage you to take advantage of them! In addition, Americollect will be hosting our popular two-part webinar series on 501(r) readiness February 26th and March 5th.  Please feel free to contact us for more information at

Please don’t hesitate to reach out to us with any questions you may have. We are here to help and would love to connect with you to assist you in getting up to speed with the wonderful adventure of 501(r)!

Link to the letter:

Link to updated guidance:


Reassigned Number Database – Your Hands are Dirty! Go Scrub Them

Kenlyn T. Gretz, CEO – Americollect 

As a parent of young children, you’ll know this command well – “Your hands are dirty, go scrub them”. Be it mud or marker, a child regularly comes to the dinner table with dirty hands. Well, the Federal Communications Commission (FCC) issued its first command to go and scrub! They are asking all that use automated dialing equipment (appointment reminders, collection calls, and marketing calls) to go scrub your phone numbers to their Reassigned Number Database (RND).

According to YouMail, in 2018, an estimated 48 billion robocalls were placed to cell phones. This is up 60% from 2017. The jump has placed more attention on all phone calls to cell phones, even legitimate calls from your organization.

The FCC is trying to tackle this problem issue by issue and one of those issues is reassigned phone numbers.  According to the FCC, approximately 35 million telephone numbers are disconnected and aged each year. Along with this, wireless carriers reassign approximately 100,000 numbers every day and normally after only 90 days.

How does this apply to hospitals? When the owner of the wireless number changes, so does the permission tied to the number according to the Telephone Consumer Protection Act (TCPA). A short recap on TCPA: If a patient gives you a phone number, you can use an auto-dialer to call or text it for medical purposes. If for collections or marketing purposes, we highly recommend having language in your admission contracts to achieve the “express permission” required by the law. But having permission or having been provided a phone number by the patient does NOT protect you when the phone number now belongs to a new party; this is called phone number reassignment.  The new owner of that wireless number has NOT given you permission.   This is where TCPA liability can stack up big at $500 per phone attempt by automated telephone dialing systems (ATDS) regardless if it is for medical, collection, or marketing purposes.

In 2015, FCC attempted a solution of “one chance” to dial a reassigned number. The FCC stated that “callers who make calls without knowledge of reassignment and with a reasonable basis to believe that they have valid consent to make the call should be able to initiate one call after reassignment as an additional opportunity to gain actual or constructive knowledge of the reassignment and cease future calls to the new subscriber.” In 2018, this “one chance” was removed as part of litigation against changes to the TCPA by the FCC. The problem with a “one call” safe harbor is that a majority of “informational” phone calls are done with prerecorded messages. These prerecorded messages aren’t able to determine if they are calling the right party. This was great news for all that make phone attempts to consumers.

The second solution is that the FCC will create a reassigned number database (RND). All companies will need to search this database before making an attempt. The wireless numbers are to be checked along with the last date the caller verified the number belonged to the patient.   For example, a provider would send phone number 920-682-1234|09-13-2018 where the date of service was 9-13-2018.  You will receive back one of three options:

  • No – the phone number has not been reassigned since 9-13-2018
  • Yes – it has been reassigned since 9-13-2018, you will want to stop dialing/texting
  • No data – the phone number is not in the database

The FCC also added a safe harbor for callers using the new database. This safe harbor provides protection from TCPA liability when “database errors” lead to an incorrect call to a consumer. This means the scrub needs to be stored.

Sounds simple right? Well it is not, because Americollect has been performing this scrub for several years. In most Electronic Health Record (EHR) systems, there are locations for multiple phone numbers; work, home, or cell.  Few systems, if any, have a logging date of when that phone number was last “verified.”   Americollect and our software provider, Roydan, have been working on this issue for a few years and we have this built into our solution.  It is called “Contact Tracker”. With it, we log every time we “verify” the phone number, the source of where we received the number, if it is a cell phone, and other self-defined types of phone attributes. We also have the ability to know who the subscriber of the phone number is, and we monitor the subscriber ownership before we dial it.  We stop dialing phone numbers when they have been reassigned to a new subscriber.  So, the very proposal the FCC has put forth is something we have been doing for four years.

The difference is that the reassigned number database will probably be more accurate than our source of subscriber ownership.  We view this reassigned number database as an additional tool to improve our current process.

What can hospitals do to help?

First, build a field in your EHR system to log the verified number and date per phone field. With this you will need to define:

  1. Did your staff actually talk to them at that number?
  2. Was it the last date of service?
  3. Was it a face-to-face admission?

Once you have that date, then share with your vendors who help you make phone calls and texts. We realize this may not be a priority for you to create new fields in the placement or update files, but it will save us both a lawsuit!

So, go scrub! It will be good for all who are tired of robocalls!

If you would like to know more about the TCPA and reassigned number database, please reach out to Kenlyn Gretz at