As of November 2026, TSI is a medical and healthcare collection agency for hospitals, health systems, physician groups and dental practices. It works open patient balances in your name before write-off (early-out) and written-off balances in its own name as a licensed agency (bad debt). Coverage and financial assistance checks come before any request for payment, and credit reporting or lawsuits happen only with your written approval, after the 501(r) steps, where state law allows.
Results vary by payer mix and client program.
- Insurance and Medicaid checkBefore any statement
- Financial assistance screenDone
- Payment plan in your limitsOffered
- 501(r) notice periodComplete
- Coverage recheckedNone found
- Credit reporting or legal actionOnly with your written OK
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
Why medical debt needs a different kind of agency
Patients didn't choose to borrow. Part of many balances is still insurance's job, some patients qualify for financial assistance, and every account carries your organization's name into a hard moment in someone's life.
If you're tax-exempt, the IRS holds you accountable for the collection actions of agencies working on your behalf. An agency built for credit cards will treat a hospital balance like a credit card balance, and your agency's conduct is your conduct.
How to choose a medical collection agency
Five questions separate agencies built for patient balances from the rest:
- Does it check for insurance and Medicaid, and screen for financial assistance, before asking a patient to pay and again after placement?
- If you're tax-exempt, does it track your 501(r) notification and application periods and pause extraordinary collection actions while an application is open?
- Do credit reporting and lawsuits need your written approval, and does it check what the patient's state allows?
- Does it report early-out and bad debt separately, by placement month, so a strong number in one stage can't hide a weak one in the other?
- Can you verify its state licenses on NMLS Consumer Access, and will it sign a HIPAA business associate agreement? TSI's NMLS ID is 950422.
Two stages, in the order patients reach them
Early-out self-pay works open balances in your name, before write-off. It checks coverage, screens for financial assistance, reaches patients by text, email and statement, and sets up payment plans within your guidelines.
Bad debt recovery starts after you write a balance off. TSI works it in its own name as a licensed agency, under your financial assistance policy, and returns any account where coverage turns up.
Godbey Group consultants, in an HFMA Ask the Expert answer (2012, updated 2022), recommended separate agencies for each stage. If one partner runs both, insist on results by stage and by placement. TSI reports each stage and each placement separately for that reason.
Hospital collection services for health systems
A hospital's patient balances come with more moving parts than a clinic's: several facilities, a charity care policy, an EHR such as Epic and a board that reads the bad-debt line every quarter.
TSI exchanges placement and update files with Epic daily, works every account under your financial assistance policy and reports results by facility, stage and placement month. When coverage turns up on a bad-debt account, the account goes back to billing.
Physician groups and dental practices get the same two stages at a smaller scale, usually with one practice management system and one set of payment-plan rules. See physician groups and dental practices.
Rules that shape medical collections
The 501(r) rules set a 120-day notification period and a 240-day application period from the first post-discharge statement, and a hospital that receives a financial assistance application suspends extraordinary collection actions while it decides.
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).
The federal medical-debt credit reporting rule was vacated on Jul 11, 2025, and the National Consumer Law Center counted 15 states and DC limiting medical-debt reporting as of Sept 21, 2026. From Jan 1, 2027, New York City's SHIELD Rule requires collectors to tell NYC consumers in every validation notice that medical debt can't be reported to credit bureaus (NYC DCWP FAQ, Oct 22, 2026).
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 does a medical collection agency do?
A medical collection agency recovers unpaid patient balances for hospitals, health systems and physician practices. Before write-off it can work balances in the provider's name, and after write-off it usually collects in its own name, under federal and state collection law and the provider's financial assistance policy.
What is a healthcare collection agency?
It's another name for a medical collection agency: an agency that recovers unpaid patient balances for hospitals, health systems, physician practices and dental offices, under collection law and the provider's financial assistance policy.
When should a hospital send a patient balance to collections?
Early-out can start soon after the first statement, in your name. Placement with an agency in its own name usually follows write-off. For a tax-exempt hospital, most extraordinary collection actions have to wait out the 120-day notification period under 501(r).
Is a medical collection agency covered by HIPAA?
Yes. An agency that handles patient accounts for a provider is a business associate under HIPAA and needs a written business associate agreement. TSI signs one with each healthcare client.
How is medical debt collection different from other collections?
Coverage and financial assistance come first, tax-exempt hospitals have to follow the 501(r) notice and application periods, and many states limit medical-debt credit reporting. The agency has to work inside all of that, account by account.
Can a medical collection agency report patients to credit bureaus?
Only where state law allows, and at TSI only with your written approval after the 501(r) steps and financial assistance screening. The National Consumer Law Center counted 15 states and DC limiting medical-debt reporting as of Sept 21, 2026.
What does a medical collection agency charge?
Early-out is often priced per account or at a lower contingency rate, and bad debt at a higher contingency rate. RCR Hub quotes 8 to 15 percent for early-out and 15 to 35 percent for bad debt (May 2026, vendor-quoted). TSI quotes each engagement on its own.
Does TSI work with physician groups and dental practices as well as hospitals?
Yes. See how TSI works with physician groups, dental practices and hospitals and health systems.
Can TSI work patient balances for a health system in several states?
Yes. TSI places each account under the rules of the patient's state, including that state's limits on medical-debt credit reporting and collection licensing, and reports results by facility and by placement.
See where your patient balances leak
The Denials Economics Sprint baselines one payer and denial class and shows how much reaches self-pay and bad debt, so you can judge your vendors 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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