As a medical provider, your job is hardly done after providing treatment to someone. You then have to collect payment for your services, and this can be easier said than done, especially in personal injury cases.

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.