Revenue cycle management has become incredibly sophisticated—when the payer is health insurance.
We’ve built an entire industry around clean claims, eligibility checks, contracted rates, denials management, and predictable workflows. If you’re an RCM leader, you can look at a dashboard and tell a client what’s happening in their A/R with a high degree of confidence.
But there’s a blind spot hiding in plain sight: third-party liability and personal injury (PI). And most traditional RCM models weren’t built to handle it.
In fact, many RCM firms intentionally avoid PI/TPL altogether—either because it’s messy, slow, or simply doesn’t fit their operating model. And that decision is leaving meaningful revenue on the table for both RCM firms and the provider organizations they serve.
The fact is, PI isn’t “just another payer class.” It’s its own revenue cycle—and it needs its own RCM solution.
“Third-party liability” is bigger than people think
When most people hear “third-party liability,” they picture a lawsuit. But TPL is broader than that: it’s any situation where another party (or insurer) is responsible for medical costs before a public payer like Medicaid pays—think liability insurance settlements, workers’ compensation, self-insured plans, and the like.
In the real world, this shows up constantly in care tied to accidents and injuries: • auto accidents (including Medical Payments coverage and PIP in no-fault states) • slip-and-fall or premises liability • workplace injuries and workers’ comp • other liability-driven claims where payment is ultimately case-dependent.
Traditional RCM tooling and staffing models were optimized for a world where payment is governed by claims rules and payer policies. PI/TPL doesn’t behave that way.
Why PI breaks the traditional RCM playbook
PI is a different revenue cycle because the “payer” is not an insurer adjudicating a claim in 30–90 days. The payer is often the outcome of a case.
That creates four structural problems for standard RCM operations:
1. Timeline risk
With health insurance, providers generally know what they’ll be paid and when. With PI, it can take a year, two years, sometimes longer—and the provider often doesn’t know the final collectible amount until the case resolves.
Documentation risk
PI collections depend on complete records, bills, narratives, and clean documentation. Missing pieces don’t just delay a claim—they can reduce settlement value and cause write-offs.
Communication risk
Your “payer touchpoints” aren’t a payer portal and denial queue. They’re attorneys, case managers, adjusters, and multiple stakeholders who don’t live in your RCM stack.
Incentive misalignment
The industry is fundamentally changing from pure “funding” toward servicing. Funding introduces conflicts—between the provider, the funder, and the attorney—because the incentives aren’t naturally aligned. Servicing is where alignment becomes possible, because the goal is straightforward: manage the process, preserve value, and get the provider paid appropriately.
When an RCM firm is built for insurance workflows, PI looks like a distraction. But for providers who treat injured patients, PI is often high-value revenue that also creates disproportionate administrative drag.
Here’s the most practical way to say it: A practice can be 90% health insurance and 10% PI, yet PI consumes 40% of the time because it’s not automated, not contractual, and requires hands-on case servicing from inception to settlement.
That imbalance is exactly why PI needs its own solution.
The “billions” problem isn’t hype—it’s math
I’ve said this bluntly in conversations with providers and partners: Most RCM companies are managing billions in health insurance claims but ignoring PI—and that means passing on hundreds of millions of dollars in revenue. We’re trying to be the bridge, the back office they never had.
To be clear: “billions” looks like a bold statement—until you consider how large the broader RCM market has become. Multiple market analyses project continued strong growth in revenue cycle management due to administrative complexity and the need for automation at scale.
Now layer in the provider-side reality: hospitals and health systems operate under sustained financial pressure and rising costs. When margins are tight, “recoverable” revenue that’s being mishandled or neglected matters more—not less.
Even if PI/TPL is a small percentage of encounters, it can be a large percentage of collectible upside when handled correctly.
So when an RCM firm excludes PI entirely, two things happen:
- the provider either handles it internally (often poorly, because it’s not their core competency), or
- it gets pushed to a fragmented vendor ecosystem that isn’t integrated into the provider’s standard revenue workflows.
Either way, you get leakage.
What PI RCM actually is (and what it isn’t)
A lot of organizations treat PI as: • “Send a bill and wait” • “Follow up once in a while” • “Let the attorney handle it” • “We’ll reconcile at settlement”
That’s not PI RCM. That’s passive receivables management.
PI RCM is active servicing across a case lifecycle, including: • Intake workflows specific to PI/TPL • Lien/LOP support where appropriate and legally permissible (this varies by state and situation) • Records and billing completeness as a first-class workflow • Attorney/adjuster touchpoints and status visibility • Disciplined follow-up and settlement resolution processes
In other words: PI needs an operating system, not a folder.
Why this matters to RCM firms specifically
If you run an RCM organization focused on insurance, you already have: • Distribution (thousands of providers) • Trust and embedded workflows • The core stack for insurance claims • Existing reporting, SLAs, and account management
What you likely don’t have is: • A specialized PI/TPL servicing engine • Trained teams who live in medical-legal workflows • A standardized way to work the PI backlog without breaking your margin model
That’s why I believe the future looks like modular RCM: • Insurance claims are one module Patient-pay is another • Prior auth is another • PI/TPL becomes another specialized module
Not because it’s trendy—because it’s operationally necessary.
The partnership model: embed PI servicing into standard RCM workflows
This is the initiative I’ve been focused on since joining Gain: partnering with large RCM providers to manage their PI backlog and create an integrated PI solution they can offer their clients.
The cleanest version of this is white-label servicing: • The RCM firm remains the primary vendor relationship • PI/TPL is routed into a specialized servicing workflow • The provider gets one unified reporting and one unified operating cadence • The RCM firm turns a “we don’t touch that” revenue class into a value-add line of business
Or said more directly: instead of an RCM company managing $2B of insurance-related RCM and passing on PI, they can finally offer a complete solution—without trying to build a PI department from scratch.
What “closing the PI gap” looks like in practice
If you’re an RCM leader evaluating this, here’s a practical way to approach it.
Step 1: Identify the PI footprint inside your client base
You may be surprised how many provider groups have PI/TPL receivables sitting in spreadsheets, aging into write-offs, because nobody owns it.
Step 2: Triage the backlog
Not every PI account is collectible. PI RCM requires prioritization: case status, attorney involvement, documentation completeness, statute considerations, and realistic settlement pathways.
Step 3: Standardize intake going forward
The easiest backlog to manage is the one you prevent. Intake forms, documentation checklists, and clear handoffs reduce cycle time and reduce leakage.
Step 4: Build reporting that matches the case lifecycle
Insurance A/R reporting won’t tell the PI story. PI reporting needs lifecycle visibility: “where is this case, what’s missing, what’s the next action, and what’s the expected path to resolution.”
Step 5: Operationalize the module
Once it’s repeatable, PI stops being a one-off headache and becomes a managed service line—inside your RCM offering.
In closing
Hospitals and providers spend enormous effort delivering care. RCM firms spend enormous effort collecting on insured claims. But PI is often treated like an exception—when it should be treated like a discipline.
Hospitals are not alone here. RCM firms are not “missing something obvious.” They’re running a model that was designed for a different type of payer.
That’s why I’ll keep saying it: most RCM companies are managing billions in health insurance claims but ignoring PI—and that means passing on hundreds of millions of dollars in revenue. We’re trying to be the bridge—the back office they never had.
The future of RCM isn’t just more automation. It’s better specialization—and PI/TPL is one of the most overdue specializations in the entire revenue cycle.