As of November 2026, TSI's extended business office (EBO) works unpaid and aged insurance claims and open patient balances as an extension of your business office, in your hospital's name. Teams check claim status, follow up with payers, rebill, take patient billing calls and work balances before write-off, inside your systems and under your policies.
Results vary by payer mix and client program.
- Commercial payer ARebilled
- Medicare AdvantageStatus checked
- Medicaid MCOAppeal sent
- Workers' compRecords sent
Payer portal checked. Claim reprocessed with corrected modifier. Expected payment in 14 days.
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
What aged AR is costing you
Every business office has a back shelf. Claims with no payer response. Low-balance claims nobody gets to. Workers' comp and accident claims waiting on paperwork. They sit past 90 days, then past 120, and some cross the payer's filing limit and become write-offs that were never denied.
Hiring your way out is slow and expensive, and the people you hire leave. Overtime clears a month, and next month the shelf fills again.
An EBO adds trained capacity under your name and your rules, without moving the accounts out of your system.
What's included
Insurance follow-up
Claim status checks, payer calls and portal work on unpaid claims, with automated status checks on high-volume inventory so people spend their time on claims that need a person.
Aged and low-balance claims
A focused push on the back shelf: claims past 90 days, low-balance claims and the ones close to a filing limit.
Rebilling and corrections
Corrected claims, coordination-of-benefits fixes and rebills when the payer needs something changed.
Specialty claims
Workers' compensation, motor vehicle accident and government claims, with the documents each needs.
Patient balances and calls
Statements, billing questions, payment plans and call overflow in your name, with financial assistance screening built in.
Reporting and reviews
A client portal and scheduled reports show inventory by age and payer, backed by weekly working calls, monthly service-level dashboards and quarterly reviews.
How it runs
Define the inventory
Pick the work: an aging bucket, a payer group, low-balance claims or a whole facility. TSI can take overflow or the full inventory.
Connect to your systems
TSI exchanges daily placement, update and withdrawal files with Epic, with regular inventory reconciliation, or works inside your system with credentials you issue.
Train on your rules
Staff learn your payer contracts, policies and scripts on top of about 80 hours of new-hire training covering HIPAA, the FDCPA, the TCPA and Regulation F.
Work and document
Specialists work claims by payer and deadline, and every action is noted on the account in your system.
Route what's left
Denied claims go to denial work. Patient balances go to early-out. Nothing waits on a handoff email.
Where it fits with the other stages
An EBO covers both sides of an open account. On the insurance side, claims that come back denied move to denial management. On the patient side, the EBO's balance work overlaps with early-out self-pay, which HFMA also calls pre-collection.
Both happen in your name, before write-off. After write-off, balances go to bad debt recovery, usually in an agency's name.
What you see
A client portal and scheduled reports show inventory by age and payer, cash collected, claims resolved, accounts approaching filing limits, rebills and staff productivity. Programs run with weekly working calls, monthly service-level dashboards and quarterly reviews.
Ask for results by aging bucket at placement. It shows whether the EBO is clearing old claims or skimming the easy new ones.
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 an extended business office?
An extended business office (EBO) is an outside team that works your unpaid insurance claims and open patient balances as an extension of your own business office, and TSI's EBO does it in your hospital's name, inside your systems.
What's the difference between an EBO and early-out?
The terms overlap. An EBO usually covers insurance follow-up and patient balances in your name. Early-out usually means only the patient-balance part, before write-off.
Will patients know they're talking to a vendor?
They hear your hospital's name. TSI staff follow your scripts and your disclosure rules.
Can TSI work inside our Epic?
Yes, with credentials you issue, or through daily file exchange.
Do we have to outsource the whole business office?
No. You can start with one aging bucket, payer group or claim type, and add scope once you've seen results.
How can we clear aged AR without hiring?
Hand an EBO a defined slice, such as claims past 90 days or low-balance claims, and have it work them in your system under your rules. Ask for results by aging bucket at placement, so you can see whether old claims are clearing.
Who does the work?
TSI employees do the account work. Offshore teams, where your contract allows them, handle only work that doesn't involve talking to patients.
Start with one slice of your AR
The Denials Economics Sprint looks at one payer and one denial class with a baseline, and reports overturn, paid yield, cash, time and cost per claim, so you can judge an EBO on 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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