Regional Hospital System: Aged Self-Pay Balances
The Challenge
A regional hospital system with three facilities and over 400 beds was facing a growing crisis in self-pay collections. With $2.3 million in aged patient self-pay balances — many over 120 days past due — the hospital's internal billing team was overwhelmed. Staff turnover in the billing department had reached 40% annually, and remaining team members were splitting their time between current billing, insurance follow-up, and collection calls on aging accounts. Recovery rates on self-pay balances over 90 days had fallen below 8%, and the hospital's CFO estimated that the organization was writing off over $1.5 million annually in collectible self-pay debt.
Compounding the challenge, the hospital needed a collection partner that could maintain strict HIPAA compliance, accept placement files from their Epic EHR system, and preserve patient relationships in a community where the hospital was the primary healthcare provider. Previous experiences with collection agencies had resulted in patient complaints and negative community perception, making the selection of a new partner a high-stakes decision.
The Solution
MSB implemented a comprehensive recovery strategy combining our early-out patient collection program with third-party collections for older accounts. The engagement began with a scheduled placement file from the hospital's Epic system and payment files returned for posting. MSB reviewed every account and assigned contact strategies based on balance size, age, and insurance payer history.
For accounts in the early-out phase (30-90 days), MSB's team contacted patients using the hospital's name (first-party branding), explained their financial responsibility, offered flexible payment plans, and screened patients for financial assistance programs including charity care, Medicaid, and the hospital's own sliding-scale program. Financial counselors screened patients for Medicaid and the hospital's charity care program, so eligible balances could be resolved without collection activity.
For older accounts (90+ days), MSB's third-party collectors used multi-channel outreach — phone, mail, email, and text — with empathetic, compliance-focused messaging designed to encourage voluntary payment. MSB's secure online payment portal allowed patients to make payments or set up installment plans at any time. All communications were reviewed by MSB's compliance team to ensure HIPAA, FDCPA, and state regulatory compliance.