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.

Medical liens are a risk for healthcare providers to hold. Most doctors and hospitals avoid providing treatment on medical liens and instead opt for immediate payment by treating patients with insurance or those who can pay out of pocket.

The problem with this, of course, is that nearly half (46%) of all Americans are uninsured or underinsured, and most do not have enough in savings to pay out of pocket for medical treatment. So, a medical lien on a personal injury settlement could lead to a disproportionate return for the healthcare provider.

With a medical lien, a healthcare provider could wait years for a case to settle, and after waiting, the patient could end up not receiving the settlement amount that was initially anticipated. When case values are lower than expected, this can result in healthcare providers having to reduce their medical bills and/or risk those bills going unpaid altogether.

More than that, if a healthcare provider provides treatment to a plaintiff with a medical lien in a personal injury case and then holds that lien within the practice, there is then a vested financial interest in the case settling, which ultimately can be viewed as a major conflict of interest.

The Biggest Issues of Holding Medical Provider Liens In-House

One of the primary targets of insurance defense counsels is healthcare providers holding their own medical liens. Some of their common defense mechanisms include:

• Questioning whether healthcare providers who service their own medical liens are acting 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, phone logs, and more, 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.

In short, in-house medical liens can wind up being a major headache for healthcare providers. Not to mention, medical lien management requires a lot of expertise, manpower, and/or specialized software, as well as extensive and proactive follow-up and negotiation.

The Benefits to Healthcare Providers of Using Third-Party Medical Liens

In order to avoid the headache that comes with managing and servicing medical liens in-house, many providers turn to service companies to sell their medical liens.

Some of the benefits of turning over medical liens to a third-party servicer include:

• Outsourcing is more cost-efficient
• Outsourcing increases operating efficiencies
• Outsourcing mitigates risk, including insurance defense attacks, expensive discovery demands, medical opinion bias, financial interest bias, and billed charges
• Third-party outsourcing solves many and varied legislative risks
• Healthcare providers make more money

Ultimately, medical liens require time, dedicated expert resources, due diligence, and follow-up in order to be managed properly. The benefit of outsourcing medical liens to a third-party servicing company is that they bring all of these to your portfolio of lien receivables, which often results in more liens being collected.

How Third-Party Servicing for Medical Liens Works

Before treating a personal injury patient on a medical lien, it is important to have an understanding of the case value.

In short, when a healthcare provider partners with a servicing company like Gain, the process of medical liens works like this:

1. The healthcare provider determines if medical treatment is necessary and related to the accident.
2. The healthcare provider gives the servicing company a breakdown of fees for treatment to be approved.
3. The servicing company evaluates the underlying personal injury case to see if the case is viable to enter into a medical lien agreement with the patient and his or her attorney.
4. If the servicing company assesses the case and determines it is viable, the healthcare provider is paid for the cost of the treatment after treatment is provided to the personal injury patient.
5. The servicing company recoups funds at the conclusion of the personal injury case.

All of the risk associated with placing a medical bill lien on personal injury settlements is almost completely reduced by using a third-party servicing company. Not to mention, treating this population of personal injury patients on medical liens can result in a substantial increase in patient flow, especially as attorneys start to refer their clients to the practice for treatment.

This, coupled with partnering with a servicing company that is efficient in collecting medical liens, can result in substantial cash flow and revenue for the healthcare provider.

Are you in need of assistance with managing and servicing your medical liens? Contact us today to see if Gain’s services might be a fit for your healthcare practice.

Our innovative platform is the proven leader in letter of protection (LOP) servicing, collections, and medical lien funding, and we’d love to help give you the support you need to provide quality care for your patients.

The post Why Healthcare Providers Should Never Hold Medical Liens 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.

From intake to underwriting, to uploading documents and generating the acknowledgement of purchase and the notice of liens, to case updates, additional treatment, settlement and collections, there are critical, and careful, steps that must be taken along the way to successfully service a medical lien.

Medical and legal funding, and how cases are processed from intake to underwriting and case management, needed follow up care, case updates, settlement and collections can have profound ramifications if they’re not meticulously documented.

At Gain, we are truly the anomaly when it comes to our funding practices. Instead of funding or purchasing liens and becoming a collections company (as many of our competitors are), we offer a full array of legal and medical funding solutions to provide needed funds and medical care. We also understand case valuations and carefully assess the probability of the plaintiff receiving funds, the attorney being paid, and medical bills being reimbursed, and share this critical insight with those who work with us.

Our high degree of customer service and systems enable the large-scale servicing of medical liens and also allow attorneys to focus on maximizing case values while knowing their clients’ liens are being held and serviced by a company that can approve additional funding as needed. During litigation, attorneys have one source for bills and notes, and at settlement they have one source to consolidate payoff information. This saves significant time and money. One source of underwriting also gives cases a higher probability of not being overfunded, thus leaving all parties satisfied.

An Empowered Process

Our process is steeped in expert resources and sophisticated systems, including intake specialists, underwriters, case managers, risk managers, and medical billing specialists, to name a few. All of whom have very specific functions to fulfill within a highly-defined workflow.

Case managers, for instance, are responsible for coordinating the care of injured clients across a large array of healthcare professionals. They coordinate resources and create flexible, convenient and cost-effective options for injured individuals on a case-by-case basis to facilitate quality, individualized treatment. They also establish goals, and help patients get the care they need by assisting with scheduling appointments and communicating patient progress.

These resources can explain medical conditions and treatment plans to the patient, family members and their attorneys. They’re reliable experts with incredibly relevant experience, and they usually end up being one of the closest confidants to plaintiffs during litigation and throughout treatment.

The one key denominator, as far as job functionality goes, across all of our team is this: we all share in the responsibility to improve day-to-day operations and services to ensure a best-in-class experience for what is easily one of the most difficult times for our clients – plaintiffs involved in personal injury lawsuits.

Continuous Investment

Two recent Gain reviews by our employees said this about our investment in technology:

“Advice to management: continue to invest in your technology platform. It is the best in the industry and [it] gives us a significant competitive advantage every day.” – Underwriter

“[Gain has continued] making significant investments in systems to help make everyone’s live[s] better.” – Anonymous Employee

Before legal and medical funding, plaintiffs involved in personal injury lawsuits had nowhere to turn for financial relief while they waited for their cases to settle. If they did not have enough in savings, family members to turn to or personal credit cards, they were simply out of luck. Some cases even take years to settle, meanwhile medical expenses, lost wages, and daily living expenses continue to mount.

Providing a solution – a means to an end – for plaintiffs, while being a strong partner to law firms and medical practices was how Gain got its start. To continue to be the best resource to all parties involved, we invest, and reinvest, in our process, technology and people. It’s not cheap, in fact it’s the biggest investment we make year-over-year, but it’s paying off in dividends for the people we help every day.

Because of our continuous investment, proudly:

We Are the Highest Rated Funding Company

Now there are options when it comes to choosing a funding company, and we make it a priority to provide the best service and offer the lowest fees—because we firmly believe in the importance of giving personal injury plaintiffs financial breathing room. We also make sure to listen to their changing needs – which is why we started offering Same Day Cash Advances™.

We Have the Best Reputation in the Industry

Gain’s reputation is unsurpassed for being 100 percent transparent. We are a proud member of the American Legal Finance Association (ALFA), Americans for Responsible Consumer Funding (APA) and a founding member of Americans for Patient Access (APA), which set the gold standards in legal and medical funding and assure that patients have access to needed medical care.

We are also an active sponsor of the Georgia Trial Lawyers Association (GTLA) and numerous other state associations including FJA, SCAJ, STLA, AAJ, TTLA and more. Creating meaningful partnerships and joining organizations on their missions to regulate and better service medical and legal clients is a top priority for us.

Our industry is not static, and neither are we.

To stay up-to-date on what we’re working on, please be sure to check out our blog.

The post How We Process and Continuously Invest In the Servicing of Medical Liens appeared first on Gain Servicing.

This is Part Two of a two-part series on medical funding and the current state of healthcare.

It’s not news that healthcare is becoming more and more expensive. The topic of healthcare is ruling the news headlines, coursing through our national political conversations, and affecting insured and uninsured people across the country. In Part One of this two-part series we explored the harsh reality of the rising cost of care. But what options do people have when it comes to covering the cost of expensive medical care when they’ve been personally injured and they’re staking out a lawsuit?

Medical Funding & Personal Injury Lawsuits

If someone has been injured through no fault of their own – for instance, in a traffic accident or an injury that happened while at work – and they’ve hired a lawyer to bring their case to court, waiting on the court’s resolution regarding their personal injury settlement can take months or even years. And the payout of their personal injury settlement can take even longer.

During this valuable time, surgeries for the injuries that have been sustained can’t wait. Receiving necessary medical care can’t wait. And, if this person is unable to work due to their injuries, daily living expenses can start to add up. It’s not easy to get better when financial stress and money owed starts to accumulate.

Whether someone is medically uninsured or subject to a health insurance deductible they’re unable to afford, applying for third-party and non-recourse medical funding offers personal injury plaintiffs an option to pay for these near-term financial obligations.

Medical funding covers the immediate costs, including living expenses, so the individual can focus on recovery and on their lawsuit.

Why Medical Funding Matters for Personal Injury Plaintiffs

Medical doctors are in the business of providing quality medical care. They are not in business to become financiers to those who have been personally injured. Or at least, they shouldn’t be.

Medical liens also aren’t always appropriate nor are they treated the same from state-to-state. Think about it like this: If a doctor’s financial interests become wrapped up in a plaintiff’s court case, that patient’s care can easily appear to become compromised. With a financial interest in the outcome of the case, a doctor’s testimony may be construed by defense counsel to be biased.

The focus of the doctor should remain on the appropriate level of care, and their medical opinion should be based solely on the patient’s condition. And, rightfully so, they should be getting paid for their services along the way.

Attorneys can help plaintiffs seek medical funding. But just like medical professionals, the attorney’s focus should be on what they do best: representing their clients. In most states, attorneys are precluded by various bar associations and ethics rulings from offering to cover the costs of their clients’ medical care. Like medical professionals, the integrity of their services could be compromised.

What Does Non-Recourse Really Mean?

When seeking out medical funding, in states where it is permitted, look for a non-recourse funding source like Gain. Naturally, non-recourse is the opposite of recourse financing, which are funds you agree to pay back. If you default on a recourse loan, for instance, the lender will still require repayment and can seek restitution.

Non-recourse financing, on the other hand, means you don’t pay the money back if you don’t win your case. However, if a plaintiff does win his or her personal injury case or receive a settlement, the repayment comes out of the judgment or settlement.

Non-recourse funding cash advances are also referred to as pre-settlement legal funding, since the plaintiff is receiving this non-recourse lump sum of money before the personal injury case is brought to court and/or the settlement is awarded.

Get Covered for Your Care

With zero out-of-pocket costs, and even the possibility to receive funding the same day you submit your application, medical funding is an option to cover the costs of medical treatment, no matter how expensive the care is anticipated to be.

When a third-party company provides medical funding, you can be certain your medical treatment and legal representation will not be compromised and there will be no competing interests at stake in your case.

If you’ve suffered a personal injury through no fault of your own, medical funding allows you to focus on getting better. You no longer need to worry about how you’ll pay your expensive medical bills from an incident that was never your fault in the first place.

Need funding for your medical expenses? Explore Gain’s medical funding options and get the financial assistance you need quickly and easily.

The post Seeking a Solution: How Medical Funding Alleviates the Rising Cost of Medical Care [Part Two] appeared first on Gain Servicing.

This is Part One of a two-part series on medical funding and the current state of healthcare.

The landscape of healthcare is already on a slippery slope. But what’s more terrifying is that no one, insured or uninsured, is exempt from the steep costs of healthcare.

Skyrocketing health care costs are leaving people across the country feeling squeezed. Even with insurance, Americans are often unable to pay what they owe after receiving treatment.

Healthcare continues to be a hot topic, and the rising costs of care are making things even more controversial. In a recent Gallup poll regarding the health care system, 54 percent of respondents said they worry a great deal about the affordability and availability of care. Another Gallup survey reports that last year, a whopping 38 percent of Americans put off needed medical care for themselves or a family member due to cost.

Healthcare Facts & Figures

An article by The Atlantic described the insured-uninsured conundrum this way: “Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills.””

In fact, there are roughly 27.4 million people in the United States right now without health insurance, while more than two of five working-age adults are underinsured. It’s not the availability of care that’s the issue – it’s being able to pay for it. After receiving care, people are crippled by the cost.

With nearly one-third of Americans feeling unable to rely on medical care (let alone being able to afford it), a lot of people have started to take matters into their own hands. Fewer and fewer people today seek preventative care or schedule routine appointments. Without regular check-ups, diseases, conditions, and the severity of diagnoses escalates. By the time medical care is received, the cost of care has virtually spiraled out of control.

Expecting the Unexpected With Healthcare Costs

An unexpected visit to the emergency room can be detrimental to a household budget.

Sarah Kliff, Senior Correspondent at Vox.com, is one of the country’s leading health policy journalists. To make sense of the unpredictable and costly reality of medical expenses, Kliff focused on one thing for a whole year – reviewing patient bills from their emergency room visits. Her laser focus on the ER stemmed from the fact that millions of people visit the emergency room each year, making the ER one of the more frequent ways individuals interact with the healthcare system. She sifted through 1,182 medical bills, and her conclusion was unequivocal. Medical prices are unpredictable – and they are skyrocketing.

Initially, Kliff was most interested in the facility fee. What did it cost to simply walk through the doors of an emergency room? Depending on the hospital and how severe a patient’s case was, she found an ER facility fee could range from as much as $533.00 per visit to as high as $3,000.00.

Of course, no one expects to end up in the ER. And, in general, Kliff found these patients paid the visit for pretty typical ER circumstances, like car accidents, pain from a heart attack, or a ruptured appendix. In one visit from Kliff’s research, a girl had eaten a coin.

But what Kliff also found is that, like the facility fee, the cost of care varied from ER to ER. For instance, in many cases, before a doctor could determine the course of care for a woman, he or she would order a pregnancy test. In one ER in Texas, a pregnancy test cost $236.00. In Illinois, it was $147.00, while in Georgia, the test was $465.00. For perspective, a pregnancy test on Amazon costs about $7.00.

In another example, bacitracin cost an ER patient in Tennessee $1.00, while a patient in Seattle was charged $76.00 for the exact same tube of this common antibiotic ointment.

Since prices aren’t public, patients aren’t aware of the cost – and it isn’t until weeks or months later when the medical bill arrives in the mail that they realize how much they owe.

What Happens When Working Families Can’t Afford Healthcare?

Even working and insured families are having a hard time keeping up with the cost of healthcare. And in reality, the cost burden of insurance premiums is growing faster than income.

In 2018, Kaiser Health News profiled a family earning $100,000 a year. They didn’t experience any major health issues that year and were insured through an employer-sponsored insurance program. Still, they managed to rack up $12,000 in medical debt. The cost of getting sick – even minorly so – is high.

The Federal Reserve Board’s annual report on the Economic Well-Being of U.S. Households found that 37 percent of Americans could not come up with $400 in an emergency without turning to credit cards, family and friends, or selling off possessions. In the world of medical bills, $400 is a drop in the bucket – in most instances, $400 wouldn’t even cover the facility fee upon arriving at the ER, or the pregnancy test if you’re a woman living in Georgia.

Potential Solutions

Despite the scary reality of the situation, there are some solutions to these crippling costs:

• Transparent pricing. When presented with the costs associated with treatment, healthcare consumers are empowered to make informed decisions about their care. Not all, or even most, medical facilities offer transparent pricing, but the rise in consumer concerns is setting the foundation for it to become more popular, and hopefully someday even the norm.
• More urgent care centers. The rising cost of ER visits is one of the primary reasons there have been more urgent centers being built. Simply put, they are a lower cost alternative to hospital visits.
• Policy initiatives. Governmental organizations, think tanks, and other experts continue to develop and champion policy proposals to help curb rising healthcare costs. These initiatives include:
  • Capping commercial hospital prices at 200 percent of the Medicare rate
  • Increasing oversight and regulation of hospital consolidations
  • Reducing prescription drug costs, and reforming the costs associated with services performed in a hospital outpatient treatment center vs. in a surgical center or physicians’ office
• Medical funding. If a patient is unable to pay their medical bills after sustaining a personal injury such as an auto or workplace accident, applying for third-party and non-recourse medical funding can help cover expenses.

Coming Up Next: Why Medical Funding Matters

Amidst the rising costs of healthcare, medical funding is more important now than ever before. The next edition of this two-piece spotlight will answer:

• What is medical funding?
• Why is medical funding becoming a necessary part of personal injury lawsuits?
• What are the benefits to attorneys and plaintiffs of having one company provide medical funding?

The post Setting the Scene: The Rising Cost of Healthcare [Part One] 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.

The post The Opportunity With Letters Of Protection For Medical Providers appeared first on Gain Servicing.

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.

The post Lien Management Best Practices appeared first on Gain Servicing.