Medical receivables are sold as patient-responsibility balances, not as gross charges. The buyer has to be able to identify the provider, the dates of service, and the amount that remained after insurance. This article describes what a sample of those bills should show.
Medical receivables are charged-off or delinquent bills from care, not a general unsecured loan. The balances are often smaller. The records are more sensitive. A buyer who treats the file like a bankcard tape will misread both the price and the work.
Authority to sell
Start with the provider or the billing company’s right to transfer the account. A facility name on a spreadsheet is not an assignment. The chain has to show the legal entity that generated the bill and each transfer after that. If a collection agency worked the account but never bought it, the agency is not the seller unless an assignment says so.
What the sample should open
| Open this | You are checking |
|---|---|
| Itemized statement | The balance on the tape matches a bill, not a round number. |
| Guarantor | The person on the account is the person the file says owes it. |
| Insurance notes | Payments and write-offs already applied are not still in the face. |
Privacy is part of the operations plan. The buyer’s systems have to hold medical billing records under the agreements they sign. This desk does not collect the accounts and does not review a buyer’s HIPAA program as if it were counsel. It does expect the buyer to say who will hold the images.
Price the product on its own. Do not borrow the credit-card discussion range. Context for other products is the pricing study and portfolio categories.
A file that should be split
A billing company sends hospital facility bills and physician-group bills in one face amount, two originators, one “media yes” column. Split the tape by the entity that generated the bill before anyone bids. A buyer who can hold facility statements may not have a contract path to the physician group. One percent of face across both is a guess.
Open twenty-five bills and write what is on them
A medical sample is a stack of bills, not a media flag. On each bill, record the provider’s legal name, the dates of service, whether the bill is itemized, whether insurance posted, and the patient-responsibility amount. If the tape’s balance is the patient-responsibility amount, the bid uses that amount. If the tape’s balance is the gross charge before insurance, the file is not ready. Say which figure the column is, in the header of the tape, before the sample starts.
| On the bill | Why the bid uses it |
|---|---|
| Provider legal name | Has to be the seller, or a party the seller has authority to sell for |
| Dates of service | Places the account. A statement date is a different date |
| Insurance posting | Shows whether the balance is still a gross charge |
| Adjustments and charity flags | Amounts the provider already took off are not unpaid principal |
| Itemized lines | A balance-forward line with no services is a weak statement |
Facility bills and physician bills
A hospital facility bill and a physician-group bill can arise from the same visit and still have two originators. Split the tape by the entity that generated the bill before anyone prices the face amount. A buyer with a contract path to the facility may have no contract path to the group. Authority to sell is the first question on each entity. Product context sits with the other categories on portfolio categories.