As of November 2026, TSI's early-out service works open patient balances in your hospital's name, before write-off. It checks for insurance and Medicaid coverage, screens for financial assistance, then reaches patients by text, email and statement, calls when a conversation will help, and sets up payment plans within your guidelines. Accounts that don't resolve move to bad debt on your write-off schedule.
Results vary by payer mix and client program.
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- Insurance and Medicaid checkCoverage found
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Why self-pay balances go bad
Self-pay balances usually go bad for fixable reasons. Nobody reached the patient in time, nobody checked whether Medicaid would have covered the visit, or the first real conversation came from a collection agency.
Each of those costs you. A balance that could have been billed to coverage gets written off instead. A patient who'd have qualified for charity care gets a collection letter, and your hospital gets the complaint. A balance that would have paid on a 6-month plan becomes a bad-debt placement with a higher fee.
January 2027 makes the window shorter. For Medicaid applications on or after Jan 1, 2027, retroactive coverage reaches back only 1 month before the application month for expansion adults and 2 months for everyone else, down from up to 3 (CMS, November 2025, on section 71112 of the One Big Beautiful Bill Act). An expansion adult who applies 2 months after a visit may find it isn't covered.
What's included
Coverage first
A coverage check before the first statement, and again when renewal timing suggests coverage may have changed. Accounts with coverage go back to billing before the patient is asked to pay.
Financial assistance screening
Your financial assistance policy (FAP) is built into the workflow, and presumptive charity scoring flags patients likely to qualify before collection starts.
Contact in your name
Texts, email, statements and calls from your hospital, on your scripts. Patients hear your name, and they can pay online, by phone or with a digital wallet.
Payment plans that fit
Plans within the terms you approve, set up on the first call where possible, with reminders before each payment.
Patient questions answered
Billing questions, estimate disputes and complaints are logged and routed under your rules, so a confused patient doesn't become a written complaint.
Results by placement month
Reports show coverage found and returned to billing, charity referrals, payments and plans by placement month, and accounts handed to bad debt.
How it runs
Place on a schedule
Self-pay and balance-after-insurance accounts arrive in daily files from Epic or your system, under the placement rules you set.
Check and screen
Coverage and charity screening run before any request for payment.
Reach the patient
Statements and outreach go out in your name, sequenced by balance and the patient's history.
Resolve or return
Patients pay, set up a plan or apply for assistance. Accounts with new coverage return to billing for rebilling.
Hand off at write-off
Accounts still open at your write-off point move to bad debt in weekly files, with the 501(r) dates, FAP status and dispute history attached.
Where it fits with the other stages
Early-out sits between your own statements and bad debt. HFMA describes early out, sometimes called pre-collection, as outsourcing open accounts to a business affiliate "as an extension of the provider's patient accounting department."
It overlaps with an extended business office, which adds insurance follow-up to the same balances. When the account reaches your write-off point, it moves to bad debt recovery, usually in an agency's name. Weekly write-off files keep the two inventories in step, so nothing is worked twice or dropped. The medical collection agency overview shows both stages side by side.
Rules that shape the work
Since Jan 1, 2022, uninsured and self-pay patients have had the right to a good faith estimate under the No Surprises Act, and a patient billed at least $400 above it can dispute the bill (CMS). Your early-out vendor should know which accounts carry an estimate or an open dispute.
Whether an early-out vendor working in your name is also a debt collector under federal law depends on the facts, including whether the balance was in default when the vendor received it. Ask your counsel, and ask each vendor which state licenses it holds.
Medicaid's 2027 changes, including 6-month renewals and work requirements by Jan 1, 2027, raise the odds that a patient covered at registration is uninsured by billing time.
What you see
Reports show accounts placed, coverage found and returned to billing, charity referrals, payments and plans by placement month, complaints, and accounts handed to bad debt. Ask for liquidation by placement month and the share returned to billing, side by side.
General information, current as of November 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The company behind the work
Questions buyers ask
What is early-out self-pay?
Early-out self-pay is outsourced follow-up on open patient balances before write-off, and TSI's version works them in your hospital's name, checking coverage and financial assistance before asking anyone to pay.
How do hospitals choose an early-out vendor?
Ask whether it checks coverage and screens for financial assistance before the first request for payment, works in your name on your scripts and connects to Epic or your system. Ask for liquidation by placement month next to the share returned to billing, and ask which state licenses it holds.
What does early-out cost?
RCR Hub, a revenue cycle vendor directory, reported early-out is "typically priced on a fixed fee per account or a lower contingency rate of 8 to 15 percent" (May 2026, vendor-quoted). TSI quotes each engagement on its own.
Can one partner handle both early-out and bad debt?
Yes. TSI works early-out in your hospital's name and bad debt in its own, as a licensed collection agency, with results reported by stage so you can judge each one.
When does an account move to bad debt?
When you write it off under your own policy and place it with an agency.
Does TSI work with Epic?
Yes. TSI exchanges daily files with Epic or works inside your instance with credentials you issue.
Measure your self-pay before 2027
The Denials Economics Sprint baselines one payer and denial class and shows where balances leak to self-pay, so your early-out decision rests on your own numbers.
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
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