There are tools that are essential to combating major medical expenses for personal injury patients: your health insurance policy, and letters of protection, or LOPs, especially for those who do not have health coverage or are underinsured.  

Using health insurance for personal injury treatment 

If you are injured in a car accident and are facing medical bills, you absolutely can and should use your health insurance plan to cover your expenses – even if you are not at fault in the incident. However, there are pitfalls to get the most out of your policy and avoid a denial of your claim.  

Pitfalls to avoid 

■ You may need to use car insurance first: Some health plans explicitly state that health coverage is ‘secondary’ to car insurance when it comes to treatment for injuries sustained in a car accident. Check your plan to see if it has this language, and, if it does, you need to use what you can in your car insurance policy. Once you have exceeded coverage limits, then move on to your health insurance coverage.  

■ Be aware of out-of-network limitations: If you choose to use health insurance, be sure to check if a medical provider you want to see is covered by the insurance company’s network. There may be restrictions on out-of-network providers.  

■ Treatment coverage limits: Likewise, some alternative treatments for your injuries may not be covered by your health plan, so be sure to check in advance if a certain type of treatment is eligible.  

■ Health insurer’s expectation of reimbursements: If you’re trying to piece together health and insurance and other sources of payment like a settlement to cover a massive medical bill, you may need to rethink that strategy: if money is coming in from another source, such as the at-fault driver’s car insurance, your health insurer will try to get some of the money it paid out back.  

■ Out-of-pocket expenses: Another thing to watch out for with health insurance is the many types of out-of-pocket expenses you will run into from the start. A quick refresher:  

► Deductible: The amount you have to pay before health coverage kicks in. The average deductible for employer-sponsored health plans in 2022 was $1,763, according to the Kaiser Family Foundation. For an estimated 28% of Americans, that would wipe out their limited savings and leave them still trying to find the remaining $763.  

► Co-pay: Your insurance might also require a co-pay for doctor visits and prescriptions. This often breaks down as the insurance company picks up 80% of the cost, leaving 20% to you. Here’s the key point: Even after you’ve reached your deductible, you will continue to have to cover the co-pay.  

► Out-of-pocket maximum: This is the point at which the health insurer picks up 100% of the costs. While you may be relieved to finally reach this point, individuals will have to pay out an average of $8,700 beforehand and families will have to cover $17,400. Remember: you will still need to continue paying your premium. Plus, if you have any out-of-network providers who are not covered, you will still be responsible for those bills as well.  

The bottom line: Your health insurance is a vital resource for you in addressing medical bills due to a car accident injury, but it’s probably best to use it as a backup, after exhausting your car insurance options, and perhaps while you’re waiting for a settlement.  

Using letters of protection (LOPs) for personal injury treatment 

For many personal injury patients, a letter of protection, or LOP (sometimes also referred to as a medical lien) can ensure they receive the care they need. For those without insurance, or who are underinsured, an LOP can be a financial lifeline.  

What it is: An LOP is essentially an agreement among the personal injury patient, a medical provider, and the attorney for the personal injury case in which payment is guaranteed to the provider from the legal settlement with an at-fault driver’s insurer.  

How it helps: An LOP means a personal injury patient does not have to wait for the resolution of their settlement to receive the medical care they need.  

Additional advantages 

■ Fair compensation: Some attorneys argue that letters of protection help personal injury patients get fair compensation in their cases.  

■ Communication between doctors and lawyers: LOPs also ensure that medical treatment aligns with the legal case. Those may seem like two entirely different processes, but treatment needs to be consistent with the arguments being made in a personal injury case. As two Texas-based attorneys note in an article on LOPs, “All too often a provider can unknowingly fail to address important issues that they do not normally focus on; for example, the cause of the injury or its impact on pre-existing conditions. As a result, plaintiffs benefit from providers who prepare medical records that clearly state the cause and extent of injury, and identify any future needs required because of those injuries suffered.” 

■ Doctors support for the legal case: Doctors treating a personal injury patient also can be witnesses in the trial. If there is an LOP in place, there is no need to pay them as medical experts, as the above attorneys note.  

■ Full payment for medical providers: Payments made through LOPs are usually at a higher rate than those used for direct insurance payments or available through Medicare. This ensures a medical provider is fully compensated for their services, making LOP a valuable tool for maintaining a practice’s financial stability, especially given the potentially long wait of a court case.  

Potential pitfalls 

■ Attorney payments: In some agreements, attorneys ensure they get paid before anyone else does. To ensure an agreement is a legitimate LOP in which your doctor will be paid, look for this language: “We agree to pay reasonable and customary charges for medical services.” If you see an LOP that does have problematic language in it, there’s a simple remedy. As one Kiplinger’s advisor notes, just “cross out the offending language on the document, initial it, have your patient initial it, and insist upon the lawyer also initialing it and returning it to you before scheduling medical procedures.” 

■ A settlement is not guaranteed: An LOP gambles on the likelihood of a personal injury case settling in the patient’s favor. If this doesn’t happen, the patient could, in theory, be on the hook for all those large medical bills. Even if the patient wins the case, the settlement amount may be too small to cover the amounts promised to the doctor in the LOP. Sometimes an attorney can negotiate with the medical provider over this. Alternatively, doctors can sell their LOPs to a third-party servicer like Gain, which assumes the liability and risk associated with these cases.  

If you’re navigating the complexities of medical expenses after a car accident, understanding your options is crucial. Whether it’s leveraging your health insurance or utilizing Letters of Protection (LOPs), having the right tools can make all the difference in your recovery journey.  

At Gain, we specialize in providing financial solutions and support for personal injury patients, ensuring you receive the care you need without the added stress of financial burdens. Don’t let medical bills overwhelm you—reach out to us today to explore how we can assist you in managing your medical expenses and securing the treatment you deserve. Contact us now to learn more about how we can help you on your path to recovery. 

The post The Role of Health Insurance and Letters of Protection in Personal Injury Claims appeared first on Gain Servicing.

One way to better understand what Gain’s platform can do for your business is to look at what it does not do.  

But first, the do’s. 

Provide 3 product offerings for Healthcare providers 

1. Full servicing: Gain’s SaaS-based, AI-enhanced platform manages Letters of Protection (LOPs), also commonly known as medical liens, and personal injury receivables, enabling medical providers to maintain control over their liens while streamlining communication with personal injury attorneys.   Our platform allows medical providers to connect with personal injury attorneys, share key documents faster, provide case status updates, and submit invoices, all designed to ensure providers are compensated fairly without the need to sell liens to third parties. This model not only enhances operational efficiency but also addresses attorneys’ concerns, creating a win-win scenario for providers, attorneys, and patients alike by combining the best of lien management with comprehensive Revenue Cycle Management (RCM) support. 
2. Partial advance: With the Partial Advance option, Gain provides a percentage of invoice to a provider up front, helping to manage cash flow and pay operational expenses while you wait for the settlement. Partial advances also carry certain tax advantages and further reduce risk for medical providers. Gain’s partial advance also comes with the potential for revenue sharing on the back end.  
3. A/R Purchase: We understand that selling medical liens isn’t the first choice or most economical for healthcare providers, but sometimes it’s necessary to ensure you can provide care without worrying about paying your operational costs in a timely fashion. That’s why Gain offers a straightforward option to buy your medical liens. This way, you get paid upfront, removing the uncertainty of when and how much you’ll receive. Our goal is to help you focus on what you do best: caring for your patients, by offering a reliable financial solution when you need it.  

Maximize returns and minimize risk

Gain’s proprietary AI and predictive analytics maximize returns. Our services come with quality of earnings verification for private equity investors and lenders. With our full suite of lien/LOP services and funding options, you can minimize claim denials to below 2% and leverage our third-party status to minimize your risk of being targeted as having a vested interest. 

Document management

Gain’s secure document storage and messaging system makes it easy to share all necessary documents and updates, saving valuable staff time.  Having the correct documentation for treatment ensures that insurers settle for what is fair and equitable. The Gain platform is built to ensure the documents attorneys need are delivered in an expedited and efficient manner.  

Facilitate communication

Our services help medical and legal teams stay in sync, which is critical to achieving positive outcomes for the patient. On our platform, medical and legal staff can share timely updates and stay informed on the progress of care and developments for the patient.  

Foster better financial decision-making

Our AI-enhanced platform combines business intelligence with analytics to generate reports and data that will drive better business decision-making. Our platform’s analytics benchmark reimbursement amounts to thousands of similar lawsuits, helping ensure you receive what is fair and equitable. 

What We Don’t Do

Generate leads or referrals: We do not help medical providers generate leads or referrals. Rather, our platform uses a geo-locator to help attorneys find providers close to the patient. Attorneys can access a nationwide map to source medical care or search for nearby providers utilizing the client’s home address. 

Provide health insurance: Our platform does not replace the need for traditional health insurance. The Gain platform and services aim to make sure that third-party liability carriers properly compensate patients for their injuries.

Since the 1990s, the country’s largest insurance companies have been using a software program called Colossus that effectively works as a claims denial program. In adopting Colossus, insurance companies have put profits over policyholders. The Gain platform believes that injured patients, through no fault of their own, are deserving of high-quality medical care. 

Act as a health care provider: We do not provide any of the functions of a healthcare provider in delivering care. Our case managers provide requests for transportation to appointments, access to prescription cards, and other important services related to personal injury medical care, freeing up medical provider staff time and making sure patients get the care they deserve, but in no way do we make medical recommendations. 

The medical side of our portal is designed exclusively to support medical practices in their work, simplifying and taking on the administrative task load and financial risk associated with LOPs and medical liens.  

Offer legal advice: Our platform and services are designed to manage the financial and administrative aspects of medical liens and LOPs, not to provide legal counsel. Attorneys that represent plaintiffs in personal injury cases are clients of ours who use the Gain platform to track client records, obtain case status updates, and communicate with medical providers.  

When it comes to what Gain’s platform does do, the results speak for themselves. On average, we collect nearly 900 basis points more than providers do when they self-service their own medical lien accounts. As of early 2024, over $250 million of medical care has been facilitated through our platform and $800 million in medical liens have been serviced.  

Our leading personal injury management software is the industry’s most advanced way to handle LOP agreements, personal injury receivables, and medical liens. Click here to request a personalized consultation with a Gain specialist today. 

The post Gain Personal Injury Claim Management: What we DO – and DON’T DO – for your Practice appeared first on Gain Servicing.

Physicians and medical practice executives can find it difficult to manage cash flow, especially amidst the ongoing concerns surrounding COVID-19 and as elective surgeries and other lucrative procedures continue to be put on hold. Cash flow difficulties compound when medical services are provided to personal injury patients on a Letter of Protection (LOP) when payment from settlement can take years to receive.

Many practices attempt to handle LOP account balances in-house but LOPs are challenging for staff as practice management systems are not equipped to handle the complexities surrounding LOPs, including necessary and proactive follow-up measures with attorneys.

The downside, of course, is that cash flow takes a hit when LOPs are not managed properly and go unpaid. Since an LOP states that you, the medical provider, are agreeing to await payment from future settlements awarded to the patient/attorney, you can expect anywhere from six months to seven years before the practice realizes this revenue. Also, at the time of payment there may be reduction requests if the financial outcome of the legal case was not as expected. This can pose a serious risk to your payment. In response, some medical offices retain a paralegal or develop an underwriting department to screen the personal injury cases prior to seeing patients, all of which can be time consuming, costly and still result in unpaid LOP account balances.

LOP Financing Options: Third-Party, In House, Gain Servicing

Many practices sell their LOP account balances at a discount to lien financing, or medical funding, companies. This provides the practice with immediate cash flow and offloads the work of tracking, managing and collecting on LOPs, but it comes with a tradeoff. Not only does the practice give up control of the process but having a third-party manage your LOP accounts receivables (AR) can come at a severe cut in profit depending on the bid amount of the financing company on your AR balances.

But, if managed in house, medical providers lack options to increase revenue and decrease time between service and payment for personal injury treatments.

A viable alternative is to consider a data-driven financing partner, like Gain Servicing. Our technology platform is backed by artificial intelligence and data from thousands of personal injury cases – intelligence we are able to pass along to our medical partners, resulting in fewer write-offs and more paid-in-full LOP balances.

Additional, unique benefits of Gain Servicing:

• Automated LOP tracking – no more manual processes or workarounds
• Optimized revenues – our AI-powered platform enables us to compare balances and case data points to help you get a better return
• Business intelligence – detailed reporting and analytics show you how well our system is doing for you
• Referral source analysis – know exactly how patients are choosing your practice through the identification and tagging of attorney referrals
• White label options – our team can act as badged resources for your practice while collecting on LOPs, creating a consistent patient and attorney experience with your practice

In the Gain Servicing model, you benefit from our tools and technology, experience, expertise and optimization of LOPs without the risk you had previously been assuming by treating personal injury patients on LOPs and not having the right systems, processes, procedures and people in place.

A Newfound, Viable Source of Revenue: LOPs

With a financing partner like Gain Servicing, practices can open their doors even wider to personal injury and workers’ compensation patients.

Marketing for these types of patients is relatively simple. Begin first by letting physicians know that they can bring their personal injury and workers’ compensation patients who are uninsured or underinsured to your facility. Many orthopedic surgeons and pain management physicians are already treating or being approached by attorneys to treat these injured patients. You can also notify your local personal injury attorney offices or local litigation groups who legally represent potential patients of your willingness to accept their clients on a lien or LOP.

In Closing

Communication with patients and attorneys is an ongoing requirement when dealing with LOPs; otherwise, it is possible they may settle the case without paying your medical bill. A technology-driven, experienced financing company, like Gain Servicing, takes on the role of an entire collections department while additionally providing LOP-specific tools, expertise and processes. Namely, LOP receivables do accumulate and age well beyond 120 days, and if not working with a medical-legal funding company, like Gain Servicing, you will need to allocate valuable resources to keep up to date and track your LOP accounts.

When evaluating alternatives to expand your reimbursement portfolio, accepting personal injury and workers’ compensation patients on LOPs is a sound business decision and requires minimal investment to significantly increase patient volume. You can reasonably expect that by opening communication with local attorneys, you will see consistent patient referrals, especially if you partner with an expert like Gain Servicing and have an efficient process surrounding LOPs.

If your practice has already been treating patients on LOPs and you need to increase your cash flow now, seek an experienced partner to monetize that patient volume through lien purchasing or servicing. Gain Servicing has several different options available, and we can customize a solution that will result in the greatest return on investment for your practice.

More About Gain Servicing

Gain Servicing specializes in the financing and servicing of personal injury and workers’ compensation patient receivables.

Gain Servicing is a wholly owned subsidiary of Cherokee Legal Holdings, a medical-legal funding company headquartered in Atlanta, Georgia. For over 10 years, we have financed existing third-party liability accounts from patient care that has been provided at healthcare facilities and medical practices across the U.S. We provide the underwriting and up-front screening, as well as process the paperwork and conduct the necessary follow-ups with attorneys after procedures are complete. We pay medical providers for their patient care, assuming the risk while providing immediate cash flow to the practice. Our goal is to increase healthcare organizations’ cash flow now while seamlessly allowing providers to do what they do best – provide care to those in need.

Gain Servicing is the go-to solution for medical practices providing quality care to the injured, underinsured and uninsured.

The post How To Increase Cash Flow From Letters Of Protection Cont’d appeared first on Gain Servicing.

The post How To Increase Medical Cash Flow From Letters Of Protection appeared first on Gain Servicing.

What Is a Medical Lein?

It can be tempting in this kind of financial pinch to turn to anyone for help, including the medical providers themselves. Over the past few years, Felton Banks PLLC, a North Carolina-based law firm, has been calling this practice “medical lien funding.”

Medical providers who are owed money for services rendered can claim a lien against your recovery if they:

• Provide notice of the lien
• Provide medical bills for free
• Provide medical records for free

So, you can probably see how this can be beneficial to patients who suffered an unexpected injury. Basically, these laws allow medical providers to treat you today and secure payment for that treatment once you settle your personal injury claim. This is a huge relief for injured patients who can’t afford to pay out-of-pocket for their treatment, and it makes the process more manageable for everybody involved.

However, not all medical liens are non-recourse. The point of view Felton Banks is sharing above is specific to North Carolina law. For instance, the state of Texas passed paid versus incurred legislation in which healthcare providers currently holding liens cannot do so because they have determined healthcare providers are not businesses and should not be governed, in this instance, like businesses.

There are countless other examples of the complexity of medical funding and whether or not they should be non-recourse in nature, including the Michigan Covenant Medical Center v. State Farm case. What it all boils down to is that medical funding is not that simple, and the laws governing these cases vary greatly from state to state.

Benefits of Medical Lien Companies

Regardless of whether a medical lien is determined to be non-recourse or not in a given state— although an important distinction—there is still the complication of medical providers functioning like financiers.

Medical funding companies, like Gain, for instance, preserve the role of all parties. Attorneys, plaintiffs, and doctors are all best served when an independent third party is the source of medical funding.

Healthcare providers should never take on this role or have a financial interest in the outcome of a case by holding their own liens. Their job is to provide the best medical care, period. The same is true for attorneys and providing the best legal advice in pursuit of their clients’ claims.

In both situations, there’s a conflict of interest. One possibility is that a doctor’s credibility may be undermined by the defense counsel, who could emphasize the doctor’s financial stake in the case rather than sticking to the facts. Alternatively, if the funding party is involved, they might be inclined to settle the case for less than its actual value to ensure they get repaid.

Neither of these scenarios should happen. Instead, a medical funding company can assess cases independently, with no influence on or ability to affect the case outcome, ensuring an unbiased position for all parties involved.

Attorneys and doctors should have no ownership interest in the outcome of their clients’ or patients’ cases, nor should they receive any compensation other than the value owed to the doctor for their professional services at the time of treatment and the time value granted by the attorney to maximize case values.

Turn to a Medical Lien Funding Company Instead

A serious shift in conversation takes place when a defense team finds a medical provider is also funding their own services, and thus, the case. A doctor’s opinion and treatment plan should be based solely on patient needs and never on whether or not they will be paid for their services. In other legal circumstances, this is referred to as the separation of church and state.

If you’re a personal injury victim who needs a pre-settlement cash advance, an attorney who needs funding for their client, or a medical provider who needs funding for a patient, reach out to a medical funding company that specializes in personal injury cases.

At Gain, we are dedicated to helping those who need financial help in order to get the treatment they need. Contact us today to speak to our professionals about our services.

The post Why Medical Providers Should Not Become Medical Funders appeared first on Gain Servicing.

In the ideal world, everyone would have health insurance to cover their medical needs. This, unfortunately, is not the case. For those who have been injured in an accident at no fault of their own and who do not have adequate healthcare coverage but who need medical attention, their bills can be covered by a letter of protection (LOP).

For medical providers providing care to personal injury victims, LOPs are an alternate option of payment. They are to encourage providers to give care. They also serve to protect the victims of personal injury cases and enable them to receive the care they need.

Backed in-house by the medical provider, by the law firm representing the victim, or by a third party like Gain, an LOP simply states that upon resolution of the personal injury case, the balance of the medical bill(s) will be paid when the case finalizes. In return, the provider agrees to provide treatment.

In essence, a letter of protection for medical bills allows personal injury victims to receive the care they need and that they otherwise would not have been able to receive while also protecting the medical providers providing the care.

Key Issues Medical Providers Face with Letters of Protection and Solutions That Solve Them

LOPs are sent from law firms—more specifically, personal injury attorneys—directly to a medical provider. A medical funding company, like Gain, can purchase or service the LOPs from the medical provider and take on the responsibility of it, thereby guaranteeing that patients receive medical treatment even before a settlement is reached.

One letter of protection issue for medical providers is that insurance defense counsels have made them one of their primary targets. Some of their common defense mechanisms include:

• Questioning whether medical providers who service their own liens act as investors in litigation.
• Operating a playbook designed to trap providers into appearing that there is a conflict of interest, that their medical opinion is biased, and that they are “investors” in these lawsuits.
• Examining communication, including text messages, emails, and phone logs, between providers and attorneys regarding insurance policy limits, case values, ongoing case updates, settlement influence, negotiations, case involvement, and insurance opt-out requirements.
• Looking for the separation of patient and clinical records and bringing in forensic medical billing experts to search for dual charge masters, varied billing, upcoding, charges that are beyond usual and customary, and more.

Here are some of the additional challenges medical providers servicing LOPs face and the solutions Gain has created to address them:

Operational

Challenge: Practice management systems (PMSs) and revenue cycle management (RCM) platforms are not designed to track or manage LOPs, including referral source profitability. As a result, medical providers are often forced to create manual, time-consuming workarounds to track LOPs.

In our experience, it is extremely difficult to avoid instances that result in write-offs when using these types of workarounds. Additionally, there is often a large volume of receivables without known or easily managed and tracked due dates.

Solution: Gain has designed proprietary software to automate and optimize the tracking of personal injury lawsuits tied to LOPs. Capabilities include referral source analysis, automated LOP tracking, revenue optimization, reporting and analytics, and additional business intelligence to provide real-time status updates.

Communication

Challenge: Medical providers often lump their LOPs in with general accounting and billing functions. There are no special processes or subject matter experts to help ensure LOPs are being managed properly.

Solution: It is essential for holders of medical letters of protection to be in constant communication with attorneys, paralegals, and case managers to obtain underwriting information, receive case updates, negotiate settlement amounts, and perform collection activities.

Liability carriers also need to be contacted in certain circumstances. Gain’s practice is designed around and specializes in these critical forms of LOP communication needs.

Insurance Defense

Challenge: Medical providers, PMS, and RCM platforms are not equipped to object to discovery requests or know when to enter into confidentiality agreements when discovery is limited.

Solution: Maintaining healthcare provider integrity and unbiased medical opinions, as well as eliminating the financial interest in the outcome of a case, are all challenges Gain solves for medical providers.

Legislative

Challenge: Medical providers, PMS, and RCM solutions are not equipped to keep up with state-by-state legislative initiatives and legal requirements.

Solution: Nationwide lobbying efforts are key to maintaining patient access to quality medical care. Gain is a founding member of Americans for Patient Access (APA), a best practices organization committed to maintaining access to quality medical care for all patients regardless of payor source.

Letter of Protection Servicing Options for Medical Providers

There are several servicing options that Gain has evolved to address the most pressing needs of medical providers when it comes to LOPs. Our servicing options include:

Partial Advance LOP Servicing

Partial Advance LOP Servicing is a unique service for medical providers to be able to satisfy their immediate cash flow needs. Gain offers a partial payment upfront, and then once a negotiated amount is collected, we then revenue share the remainder of collections with you, the provider.

Revenue Share LOP Servicing

Revenue Share LOP Servicing is an outsourced service option for medical providers. All medical lien servicing is handled by Gain, freeing up medical providers from having an in-house team. When considering a letter of protection vs. a lien, liens are owned by you, the provider, while servicing and collections are handled by our wholly-owned company, Gain.

Note: Gain collects a fee similar to traditional RCM collection fees.

Letters of protection for personal injury victims should be considered essential. Whether serviced in-house by a medical provider, through a law firm, or through an outsourced medical funding company like Gain, it is paramount that the victims in these cases have access to the medical care they need. A trusted outsourced partner can allow you, the provider, to focus on treating more patients and getting great outcomes for them.

Our holistic approach to servicing, including technology, people, and processes, is proven to deliver higher reimbursements at a lower cost without impacting referrals. Let us help you help your patients.

If you are a medical provider with questions about a letter of protection for medical services, please contact us. We would love to discuss your practice, LOP challenges, and our services.

The post The Problem With Letter Of Protection For Medical Providers appeared first on Gain Servicing.

In our experience, doctors wish to provide high-quality medical care to as many patients as possible. Worrying about contracts, reimbursement rates and collections from a variety of payor sources is not the reason most doctors went to medical school, yet the revenue cycle management side of the business is essential to operating a successful practice.

Most revenue cycle management companies are good at contracting with a variety of payor sources and collecting patient payables. But for patients who have been injured in an accident and who do not have adequate healthcare coverage but need medical attention, these bills are more complex.

For doctors providing care to personal injury victims, LOPs are an alternate form of payment. Seeing patients regardless of payor source is an honorable pursuit. LOPs are signed by both the patient and the attorney representing the patient at the time of treatment. They simply state that upon resolution of the personal injury case, the balance of the medical bills will be paid through the attorney escrow account. In return, the provider agrees to provide treatment.

In essence, a personal injury letter of protection allows victims to receive the care they need – care they otherwise would not be able to receive – while also protecting healthcare providers.

The Key Issues Medical Providers Face with A Personal Injury Letter of Protection and Their Solutions

In today’s environment, a letter of protection is managed by medical providers and law firms or sold outright. But this is not the wave of the future. Insurance defense and various state legislatures are increasingly scrutinizing the traditional sale of medical receivables, passing legislation prohibiting or seriously limiting this option.

Gain is the future of letter of protection medical lien servicing for uninsured and underinsured patients in need of medical care. Gain provides an independent, SaaS-based, AI-enhanced, third-party servicing platform to separate medical providers from the potential for conflict of interest, biased medical opinions, and financial interest in the outcome of the case while servicing these receivables rather than purchasing them.

This allows patients to receive needed medical care without the undue pressure that traditional medical funding can put on the case settlement. By servicing liens on behalf of medical providers. Gain also provides a variety of financial solutions that maintain the doctor’s independence.

One issue for medical providers holding their own patient medical liens is that insurance defense counsels have made them one of their primary targets. Some of their common tactics include:

• Operating a “playbook” designed to trap providers into appearing that there is a conflict of interest, that their medical opinion is biased, and that they are “investors” in these lawsuits.
• Examining communication, including text messages, emails, phone logs, and more, between providers and attorneys for communication regarding insurance policy limits, case values, ongoing case updates, settlement influence, negotiations, case involvement, and insurance opt-out requirements.
• Looking for the separation of patient and clinical records and bringing in forensic medical billing experts to search for dual charge masters, varied billing, upcoding, charges that are beyond usual and customary, and more.

Here are some of the additional challenges healthcare providers accepting medical letters of protection face and the solutions Gain has created to address them:

Operational

Challenge: Practice management systems (PMSs) and revenue cycle management (RCM) platforms are not designed to track or manage LOPs, including referral source analysis. As a result, medical providers are often forced to create manual, time-consuming workarounds to track LOPs.

In our experience, it is extremely difficult to avoid instances that result in write-offs when using these types of workarounds. Additionally, there is often a large volume of receivables without due dates.

Solution: Gain has designed personal injury case management software to automate and optimize the tracking of lawsuits tied to LOPs. Capabilities include notice of service, all needed filings, automated case updates, automated LOP tracking, referral source analysis, revenue optimization, reporting and analytics, and additional business intelligence to provide real-time status updates.

Communication

Challenge: For medical providers, rather than having a single point of contact or payor source, personal injury patients require complex communications with case managers, paralegals, the patient, attorneys, and third-party liability carriers. The management of these communications alone is not easy and is not readily available in current RCM, EMR, or Billing Systems. Failure in these areas leads to higher charge-offs.

Solution: It is essential for holders of LOPs to be in constant communication with attorneys, paralegals, and case managers to obtain underwriting information, assess case characteristics, receive case updates, negotiate settlement amounts, and perform collection activities. Liability carriers also need to be contacted in certain circumstances. Gain’s practice is designed around and specializes in these critical forms of LOP communication needs.

Insurance Defense

Challenge: Insurance defense attorneys are attacking medical providers who hold LOPs and communicate with attorneys to attempt to show bias through the discovery of case communication between attorneys and doctors, the exchange of case estimates, policy limits, and more.

They often claim charges are excessive and that professional opinions are biased. This also leads to high costs for medical providers due to legal responses, objections, discovery, and longer depositions. Medical providers, PMS, and RCM platforms are not equipped to object to discovery requests or segment any of this information to avoid these potential objections.

Solution: Maintaining healthcare provider integrity and unbiased medical opinions, as well as eliminating the financial interest in the outcome of a case, are all challenges that Gain solves for medical providers.

Legislative

Challenge: Various legislatures have attempted to eliminate traditional medical funding in order to force healthcare providers to hold liens and then have insurance defense attorneys attempt to show the bias outlined above.

Solution: Nationwide lobbying efforts are key to maintaining patient access to quality medical care. Gain is a founding member of Americans for Patient Access (APA), a best practices organization committed to maintaining access to quality medical care for all patients regardless of payor or source. Lien servicing is the future, and Gain is the industry leader.

Letters of Protection Servicing Options for Medical Providers

There are several servicing options that Gain has evolved to address the most pressing needs of medical providers when it comes to LOPs:

• Medical Funding: Gain provides cash advances to patients, so you receive payment at or near the time of service rather than waiting until cases are resolved.
• Medical Lien Management Services: Holding medical liens in-house poses substantial risks to your practice. Gain offers comprehensive lien management services to transfer the responsibility for negotiation and collection from you to us.
• Unpaid Medical Lien Purchasing: Gain will purchase your unpaid medical lien receivables at the highest prices to take them off your books and give you an immediate cash infusion.

Personal Injury LOPs serve a critical need for victims. They are traditionally serviced in-house by a medical provider, through a law firm, or sold to a medical funding company. Each of these options is outdated, similar to the situation Kodak and Polaroid faced when they knew that digital film was coming but chose not to cannibalize their own businesses, instead going bankrupt.

At Gain, we see the future and are willing to cannibalize our own business for the benefit of patients, doctors, and the legal community. It is paramount that the victims in these cases have access to the medical care they need. A trusted outsourcing partner can allow you, the provider, to focus on treating more patients and getting great outcomes for them.

Our holistic approach to servicing, including technology, people, and processes, is proven to deliver higher reimbursements at a lower cost. Let us help you help your patients.

If you are a medical provider with questions about medical lien servicing, please get in touch with us. We would love to discuss your practice, LOP challenges, and our solutions.

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In a single personal injury case, there may be multiple lienholders. Health insurance companies, for example, may issue a lien against the at-fault party to recover any money they spend on treatment as a result of an accident. This is known as subrogation, or the substitution of one person or group by another in respect to a debt or insurance claim, accompanied by the transfer of any associated rights and duties.

Insurance providers with subrogation claims can seek repayment from plaintiffs settlements; although, it is important to note, some states prohibit subrogation clauses altogether in health insurance policies. Medical providers who provide medical treatment may also issue a lien on a case and provide services under a letter of protection (LOP), which states that the balance of all unpaid medical bills will be paid upon resolution of the personal injury case.

In short, any group, organization or entity that provides services on contingency to a plaintiff, no matter what they are, can become a lienholder in that plaintiff’s case.

Lien Confirmation

Because there can be so many lienholders in an individual case, it is important for lienholders to confirm their lien agreements with the plaintiff’s attorney. Even after a lien agreement has been signed and put on file, which means something different for every firm, it is important for lienholders to confirm their liens and to follow-up on the case regularly. Because personal injury cases can take months or years to settle, proactive and diligent lien management is critical.

Not only can there be dozens of lienholders in any one case, any one plaintiff attorney can be working on a number of personal injury cases. And, despite digital transformation efforts within the industry, oftentimes, plaintiff attorneys are still relying on paper filing, verbal conversations and outdated computer systems. Ultimately, it is up to the lienholder to follow-up on what they are owed. Often, a case may settle without all lienholders being properly informed of the settlement.

In brief, here is how lien confirmation works:

The lienholder confirms the attorney is a reliable escrow agent and that there is a legal agreement in place for the lien.

Within a few days or a week of services being provided, the lienholder confirms the following with the plaintiff’s attorney: the plaintiff’s name, the service provider’s name, the type of servicing (financing, surgery, etc.), the date services will be or have been provided, and that all of this information, i.e. the lien, is on the plaintiff’s file.

Confirming and tracking the status of a lien is essential to ensure proper recovery. As a lienholder, it is a good idea to create a regular follow-up schedule and to be diligent about confirming the lien is still associated with the plaintiff’s file.

At Gain, we have developed an AI-powered platform to track and manage all LOPs and liens. Because a lien can be arranged before services are provided, the lien is not officially in place until it is executed on all sides. Meaning, service providers can obtain written acknowledgement of their liens ahead of services being provided, whether that be medical services or funding to plaintiffs, but they do not technically have a lien until services are actually provided.

It is not uncommon for plaintiffs or service providers to change their minds or alter provisions of the services after a lien agreement has been verbally discussed, which is why confirmation and follow-up after the fact is necessary. A lien has been fully executed when service has been provided, for example the plaintiff has received treatment or has been advanced money.

Confirmation by phone and/or email can be simple examples are included below. Note: When calling an attorney’s office, be sure to note the date, time and who you spoke with.

Hi, this is [Name] from [Company/Service Provider] confirming that [Plaintiff Name] received [Service – Treatment or Funding] from [Company/Service Provider] following his/her accident on [Date of Loss]. Has this been notated as a lien on [Plaintiff Name]’s file?

Following a verbal confirmation, it is always a good idea to then send an email. You can let whoever you spoke with know that you will be following up with an email to the appropriate case manager, paralegal or attorney so that you and they have record of the conversation. Print records are paramount.

Hi [Case Manager/Paralegal/Attorney],
We provided [Plaintiff Name] with [Service Treatment or Funding] on [Date of Service]. Attached are the [Medical Bill or Financing Agreement] and signed lien agreement for your records.
Please reply to this email confirming that you have our lien on file.

Additionally, you can add a Read Receipt to the email you send, as well as send a confirmation by certified mail.

It may sound excessive, but effective lien management is an essential part of the personal injury case process. Best practices are not complicated, and diligence and good communication go a long way.

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Fact: 46 percent of Americans are uninsured or underinsured. Treating patients on an LOP or a lien enables providers to treat personal injury patients – 84.2 million of which are uninsured or underinsured. But, the business aspects of servicing the treatment of patients on LOPs and medical liens are more complex and costly than most realize.

One solution for providers is to sell their LOP receivables and medical liens.

What is a Medical Lien?

A lien is a document that states you, as the medical provider, will be paid from the proceeds of your patient’s personal injury case. The lien is signed by your patient and his or her attorney. The patient instructs the attorney to pay for your services out of the proceeds of their personal injury case settlement. The attorney signs, acknowledges instructions of his or her client and promises to repay you at the conclusion of the personal injury case. A lien is necessary in the event that there is no insurance to pay for medical services.

What is a Letter of Protection?

An LOP is very similar to a lien; it is a letter from the attorney requesting that you, the medical provider, treat the patient with payment deferred until the successful resolution of the personal injury claim. Sometimes the attorney will put the amount he or she is willing to repay you at the conclusion of the personal injury case. Therefore, you may not get paid for treatment you provide in excess of that amount.

How to Sell LOP Receivables and Medical Liens

If your practice already treats personal injury case patients, you likely have an existing portfolio of medical liens and LOPs against personal injury cases. Accepting medical lien or LOP cases is a necessary part of treating personal injury accident patients. There are many benefits to this, of course, which include the steady inflow of patients who you would not otherwise treat and the subsequent revenue that is generated by providing treatment to this population.

But, LOP and lien practice management has its challenges:

Staff must manage, track, collect and negotiate LOPs and liens.
Services have been provided for which you hope to get paid on in the future
The practice loses value against inflation (as you are not charging interest on LOPs or liens)
In most circumstances, each personal injury case has not been evaluated to determine if there is a strong likelihood the case will bear a financial recovery, which means the practice may not get paid
Your practice is likely not trained or skilled to negotiate with lawyers, all of whom have a vested interest in reducing the LOP or lien.
The solution to this is to present your portfolio of medical liens and LOPs for analysis to a servicing company, like Gain Servicing. The servicing company will do a full review and analysis of the portfolio and present you with a purchase offer. When the sale is complete, the practice will receive a lump sum of money, which can be infused back into the practice. Subsequently, the practice is also relieved of all risk associated with those medical liens and LOPs, and all of the angst and work associated with managing and collecting on them.

Another option is to sell individual lien or LOP cases as they occur, instead of selling them off in bulk. This increases revenues more immediately without any additional risk or cost. This is best when the practice treats a patient who has been involved in an accident where there is a pending claim for damages for the injuries sustained. When there is no insurance to pay for the necessary medical services caused by an accident, either treatment is not provided or you agree to perform the treatment on a lien or LOP against your patient’s personal injury case. Either scenario poses challenges for the practice:

Scenario 1: No treatment is given.
The patient is unable to get much needed treatment.
The practice is unable to generate the revenues which could have been generated from providing treatment.
Scenario 2: You treat the patient on a medical lien or LOP.
The practice does not know if the personal injury case is viable, which means payment may never be received.
If there is payment, it may not come for several years. This, in essence, functions as an interest-free loan, of which the practice loses money on due to inflation every year.
If there is payment, the practice will likely be asked to reduce the amount of the lien or LOP.
The practice must invest in time and money to track the status of all medical liens and LOPs.
Why Sell LOP Receivables and Medical Liens

The biggest benefits of selling LOP receivables and medical liens include:

Substantially increase revenues by providing medical services that otherwise may not have been provided.
Get paid immediately for the services provided.
Gain more patients when attorneys and other medical providers know they can refer the practice lien or LOP cases.
Reduce employee time spent billing, following up and tracking liens and LOPs and trying to collect on them.
Eliminate the risk of a case being lost or of the practice not getting paid.
No longer deal with lawyers negotiating liens down as cases settle.
Remove high risk case files that a servicing company evaluates and determines will likely not settle for the initially anticipated amount.
Strengthen trial testimony as the practice is able to testify that there is no financial interest in the outcome of the trial.
In short, if there is a viable personal injury case, a servicing company, like Gain Servicing, will work out an LOP or medical lien with the patient and his or her lawyer, wherein you, as the medical provider, will be paid for services rendered with no risk or cost to you. The servicing company will evaluate the underlying personal injury case to see if the case is viable to enter into a lien agreement or LOP with the patient and his or her attorney. If the servicing company feels the case is viable, the practice will be paid for the cost of the medical services. Whereby, the servicing company will get paid back at the conclusion of the personal injury case.

With a servicing company partner, the only thing the medical service provider has to do is determine if medical services are necessary and related to the accident. Once the servicing company is called and the medical service provider gives the servicing company a breakdown of fees for services to be approved, the servicing company will then determine if it is a viable case. If the case is approved, payment will be sent upon confirmation that medical services were rendered; and then they handle the rest.

Selling lien and LOP cases is a great solution for most medical providers. Not only does it increase immediate cash flow, but the practice is able to treat a new group of patients they might not otherwise have been able to provide services for. It’s a win, win, win for the medical service provider, the personal injury patient and the servicing company.

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