Receivables under management across TSI’s services
Recovered for clients in calendar 2025
Of TSI’s healthcare clients run Epic
The year TSI started collecting
TSI company figures, October 2026. Results vary by payer mix, account age and client program.
As of October 2026, TSI’s Healthcare Revenue Cycle Management (RCM) service works unpaid and denied insurance claims, early-out self-pay balances in your hospital’s name and, as a medical collection agency, bad debt after write-off for hospitals and health systems. 501(r) steps and financial assistance screening come before any collection action, and you can start with one payer, one denial class or one self-pay tier.
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub
What the status quo costs you
Working a denial costs money. Premier’s survey of 280 hospitals put the average administrative cost of fighting a denied claim at $57.23 in 2023, up from $43.84 in 2022 (Premier, February 2025, vendor-published survey).
Below some claim value, an appeal costs more than it returns. The Denials Economics Sprint finds that line for your payers.
Self-pay carries a different risk. Send a balance to collection before financial assistance screening, and your hospital’s name ends up in the story.
How an account moves through TSI
You can hand TSI one stage or the whole path. Either way, the handoffs between stages run under one set of controls and one reporting line.
On the claims side, PULSE, TSI’s denial technology, finds the root cause of each denial and generates the appeal. SAGA works alongside it and automates low-balance claims, the ones an appeal team rarely has time for.
TSI gets your denied claims paid.
Denials, aging AR and patient balances your systems can't clear.
- 1IntakeAccounts arrive daily from your EHR. TSI's notes write back.
- 2DenialsEvery denial sorted and ranked, then worked before its deadline.
- 3AppealsPULSE drafts each appeal. Clinical staff make the final call.
- 4PreventionTSI traces each denial to its source, so your team can fix it.
- 5PatientsFinancial assistance screening first, then clear bills and easy ways to pay.
Start with one payer and one denial class.
What TSI brings
Denials and claims follow-up
Unpaid and denied insurance claims worked by payer and denial class, including clinical denials. Workers’ compensation, motor vehicle accident and government claims too.
Extended business office
Insurance follow-up and patient balances worked in your hospital’s name, on your scripts and payment-plan rules.
Bad debt recovery
Primary, secondary and tertiary placements after write-off. Credit reporting and legal action happen only when you authorize them.
Epic and reporting
Daily placement, update and withdrawal files with Epic over an encrypted connection, or work inside your instance with credentials you issue.
Early-out and bad debt, side by side
| Early-out | Bad debt | |
|---|---|---|
| When it starts | While the balance is still open in your patient accounts, before write-off | After you write the balance off and place it with an agency |
| Whose name patients see | Your hospital’s | TSI’s, as a collection agency |
| What TSI does | Statements, calls and online reminders in your name; payment plans within your guidelines; coverage checks and financial assistance screening | Primary, secondary and tertiary placements; credit reporting and legal action only when you authorize them after financial assistance review |
| Typical pricing, vendor-quoted (RCR Hub, May 2026) | A fixed fee per account, or a contingency rate of 8 to 15% | Contingency fees of 15 to 35%, higher for older accounts and later placements |
Weekly write-off files keep the 2 inventories in step. TSI reports primary and secondary placement results separately, so one doesn’t flatter the other.
Results from hospital programs
Anonymized results from TSI hospital programs. Client names are shared as references, with each client’s permission.
600+ bed regional health system
TSI took on hospital AR follow-up, denial resolution, payer escalation and aged inventory. Within the first 6 months, AR liquidation rose by more than 30% and average days to resolution fell by 20%.
Multi-hospital safety-net system
TSI worked denial management, appeals, payer follow-up and complex AR. Denial overturn rates rose by more than 25%.
TSI doesn’t publish a single denial overturn rate, because results depend on payer mix and denial class. The Sprint measures them on your claims, against your baseline.
Before any collection action
If your hospital is tax-exempt, the IRS rules under section 501(r) hold it accountable for the extraordinary collection actions (ECAs) of agencies collecting on its behalf. ECAs include selling the debt, reporting to credit agencies, deferring or denying care, and legal or judicial process. The rules set a 120-day notification period and a 240-day application period, both starting with the first post-discharge billing statement.
TSI gets your financial assistance policy (FAP) at the start and builds it into the workflow. It starts no ECA unless you authorize it, and only after FAP review. Presumptive charity scoring flags patients likely to qualify before collection begins.
Medicaid coverage rules change on Jan 1, 2027. Retroactive coverage shrinks to 1 month before the application month for expansion adults and 2 months for most others, and states begin work requirements for many expansion adults (the law lets some states ask for more time). More self-pay balances will need a coverage check before the first statement.
TSI reports medical accounts to credit bureaus only when you direct it and the patient’s state allows it.
Controls you can check
Independent oversight, led by former federal regulators. NIST-aligned controls under it.
TSI’s own employees do the work, with no subcontractors. You choose onshore, nearshore or offshore delivery. Patient complaints go to TSI’s Consumer Affairs team, and collection on the account pauses while a spoken complaint is investigated.
Questions worth asking any revenue cycle vendor, TSI included:
- Who decides on an ECA?
Ask whether the vendor can start credit reporting or a lawsuit without your written approval. - When does financial assistance screening happen?
It should come before the first collection step, under your FAP. - Whose employees work your accounts?
Ask about subcontractors and where the work happens. - How are results reported?
Ask for early-out and bad debt, and primary and secondary placements, reported separately.
Who this is for
CFOs
You want to know which claims and balances are worth the cost of working. The Sprint puts a number on it for one payer and one denial class.
Revenue cycle and PFS directors
You keep the vendors you have. TSI takes one scope beside them, on your files, scripts and reporting calendar.
Compliance and patient experience leads
No ECA without your written approval and FAP review, and collection pauses while a patient complaint is investigated.
IT and Epic teams
Daily files over an encrypted connection, or work inside your instance with credentials you issue.
Where TSI isn’t the fit: TSI works back-end revenue, meaning claims follow-up, denials, EBO, early-out and bad debt. Coding and clinical documentation are outside its scope. TSI isn’t rated by KLAS or Black Book and has no HFMA Peer Review listing today, so ask for references, which TSI arranges with each client’s permission.
Each engagement is quoted on its own, with no public rate card. Other healthcare pages: physician groups, dental practices and DSOs and insurers and health plans.
Frequently asked questions
What's the difference between early-out and bad debt?
Early-out works open balances in your hospital’s name before write-off. Bad-debt collection starts after write-off, in the agency’s name, and adds federal collection-law duties.
Will TSI sue our patients or report them to credit bureaus?
Only with your written approval, after 501(r) steps and financial assistance screening. Credit reporting also has to be allowed in the patient’s state.
Does TSI work with Epic?
Yes. TSI exchanges daily files with Epic or works inside your instance with credentials you issue.
Can we start with one scope?
Yes. You can start with one denial class or with early-out self-pay, beside the vendors you keep.
What does TSI need from us to start?
Your financial assistance policy, a sample placement file, and your scripts and payment-plan rules for early-out work. TSI builds the FAP into the workflow before any account is worked.
Does TSI use subcontractors?
No. TSI’s own employees do the work, and you choose onshore, nearshore or offshore delivery.
What happens when a patient complains?
The complaint goes to TSI’s Consumer Affairs team, and collection on the account pauses while a spoken complaint is investigated.
How does pricing work?
Each engagement is quoted on its own, with no public rate card. Early-out is often priced per account or as a contingency rate, and bad debt as a contingency fee that rises with account age.
Find the claims worth fighting
The Denials Economics Sprint looks at one payer and one denial class against a defined baseline, and reports overturn, paid yield, cost per claim and the claim value below which an appeal stops paying back.
General information, current as of October 27, 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.