How to Increase Cash Flow from Letters of Protection

By | Blog

For many healthcare organizations, managing cash flow is a regular challenge. While insurance carriers demand more and reimburse less, the time between date of treatment to when a carrier issues payment continues to increase. This time lapse adds to the difficulty of managing cash flow – and this, of course, is just speaking to the cases where patients have insurance AND have met their deductible.

Cash flow challenges increase substantially for practices that treat uninsured and underinsured personal injury patients on liens or Letters of Protection (LOPs).   The payments awarded in these cases can take anywhere from six months to seven years, and there is no way to predict when settlements will occur and when payment will be issued. Thus, LOP account receivables (AR) build up over time as do delays in payment. Most practice management systems are not set up to handle these types of claims with relative ease.

Furthermore, when LOP account balances are paid, the vast majority are not paid in full.  Almost all payments come with reduction requests.  Not only do healthcare practices not have comparative data to understand what reduction amounts are equitable, but most do not have an attorney or paralegal on staff to assess reductions or underwrite cases prior to seeing personal injury patients.

When personal injury patients are treated on LOPs, ongoing communication with attorneys is required to avoid instances where cases settle without the practice being reimbursed.  Properly tracking cases requires a significant amount of time and resources from practice staff.

Adding to this challenge is the fact that most practice management systems do not provide even the most basic tools for revenue cycle staff to manage LOP account balances. These systems are built to help providers submit electronic claims to payers like Medicare and Blue Cross, where electronic payment is received shortly thereafter. The fields, workflow, error handling and reporting capabilities do not account for the nuances of LOPs.  This leads staff to create manual workarounds that are labor intensive, not to mention prone to error.

Partnering with an LOP Financing Company

Many practices who treat on LOPs will periodically sell their LOP AR to third-party lien financing companies, also referred to as medical funding companies. This approach has two primary advantages. First, practices are paid promptly and can maintain more stable cashflow predictions.  Second, medical practices are able to avoid all of the work that goes into managing each balance for the months or years it takes for these cases to settle and for payment to be received.

Choosing an LOP Financing Company

LOP financing is a viable and attractive option, but medical providers should be selective when choosing which LOP financing company to work with. All LOP financing companies are the same in that they offer your practice cash for LOP AR; the business terms and services, however, vary greatly. There are obvious factors to consider, like cost and reputation and some less obvious criteria, like the technology platform and internal efficiency of the financing company.  There are many LOP financing companies, but few that are established, well capitalized, and expertly managed.

We recommend using a simple decision matrix, an example of which is provided below. A comparative matrix like this allows you to cross-reference companies and rank them to ensure you select the best fit for your practice. For subjective criteria, like reputation, we suggest using a 1-10 scale to help rank each company.

What terms are they offering?
How quickly will you receive funds?
How long has the company been in business?
Do they know your geographic market?
Are you confident in their servicing and collection methods?
What is their competitive advantage?

Do not underestimate the value of an LOP financing company’s competitive advantage. Gain Servicing, for instance, has an AI-powered platform that creates efficiencies for the healthcare practices that have chosen to partner with us. Take the time to ask prospective financing companies about their current capabilities and services as well as their future plans. In essence, they will be serving as an extension of your business, or, at the very least, an extension of your AR team, so make sure you land on a financing partner that you can see yourself working well with and that will deliver the most value to your practice.

About Gain Servicing

Gain Servicing specializes in the servicing and financing of personal injury patient receivables. Gain Servicing experts handle day-to-day, transactional accounts receivables functions on behalf of medical practices while office staff and providers focus on delivering exceptional care and services to patients.

Gain Servicing’s technology platform is powered by artificial intelligence and is built to track, manage and optimize returns from Letter of Protection (LOP) account balances. Gain Servicing’s financial solutions can provide immediate cash flow and the highest returns on a healthcare practice’s assets. Gain Servicing’s solutions are proven to provide higher returns, at a lower cost, than in-house or other third party LOP financing options.

Lien Management Best Practices

By | Blog

A personal injury lien is a legal right to receive a portion of the plaintiff’s settlement, typically to reimburse third parties for services rendered. Lienholders can include the state and federal government, health insurance companies, medical providers and third-party medical funding companies, like Gain Servicing.

In a single personal injury case, there may be multiple lienholders. Health insurance companies, for example, may issue a lien against the at-fault party to recover any money they spend on treatment as a result of an accident. This is known as subrogation, or the substitution of one person or group by another in respect to a debt or insurance claim, accompanied by the transfer of any associated rights and duties. Insurance providers with subrogation claims can seek repayment from plaintiffs’ settlements; although, it is important to note, some states prohibit subrogation clauses altogether in health insurance policies. Medical providers who provide medical treatment may also issue a lien on a case and provide services under a letter of protection (LOP), which states that the balance of all unpaid medical bills will be paid upon resolution of the personal injury case.

In short, any group, organization or entity that provides services on contingency to a plaintiff, no matter what they are, can become a lienholder in that plaintiff’s case.

Lien Confirmation

Because there can be so many lienholders in an individual case, it is important for lienholders to confirm their lien agreements with the plaintiff’s attorney. Even after a lien agreement has been signed and put “on file,” which means something different for every firm, it is important for lienholders to confirm their liens and to follow-up on the case regularly. Because personal injury cases can take months or years to settle, proactive and diligent lien management is critical. Not only can there be dozens of lienholders in any one case, any one plaintiff attorney can be working on a number of personal injury cases.  And, despite digital transformation efforts within the industry, oftentimes, plaintiff attorneys are still relying on paper filing, verbal conversations and outdated computer systems. Ultimately, it is up to the lienholder to follow-up on what they are owed.  Often, a case may settle without all lienholders being properly informed of the settlement.

In brief, here is how lien confirmation works:

  1. The lienholder confirms the attorney is a reliable escrow agent and that there is a legal agreement in place for the lien.
  2. Within a few days or a week of services being provided, the lienholder confirms the following with the plaintiff’s attorney: the plaintiff’s name, the service provider’s name, the type of servicing (financing, surgery, etc.), the date services will be or have been provided, and that all of this information, i.e. the lien, is on the plaintiff’s file.

Confirming and tracking the status of a lien is essential to ensure proper recovery.  As a lienholder, it is a good idea to create a regular follow-up schedule and to be diligent about confirming the lien is still associated with the plaintiff’s file.  At Gain Servicing, we have developed an AI-powered platform to track and manage all LOPs and liens. Because a lien can be arranged before services are provided, the lien is not officially in place until it is executed on all sides. Meaning, service providers can obtain written acknowledgement of their liens ahead of services being provided, whether that be medical services or funding to plaintiffs, but they do not technically have a lien until services are actually provided. It is not uncommon for plaintiffs – or service providers – to change their minds or alter provisions of the services after a lien agreement has been verbally discussed, which is why confirmation and follow-up after the fact is necessary. A lien has been ‘fully executed’ when service has been provided, for example the plaintiff has received treatment or has been advanced money.

Confirmation by phone and/or email can be simple – examples are included below. Note: When calling an attorney’s office, be sure to note the date, time and who you spoke with.

Hi, this is [Name] from [Company/Service Provider] confirming that [Plaintiff Name] received [Service – Treatment or Funding] from [Company/Service Provider] following his/her accident on [Date of Loss]. Has this been notated as a lien on [Plaintiff Name]’s file?

Following a verbal confirmation, it is always a good idea to then send an email. You can let whoever you spoke with know that you will be following up with an email to the appropriate case manager, paralegal or attorney so that you and they have record of the conversation. Print records are paramount.

Hi [Case Manager/Paralegal/Attorney],
We provided [Plaintiff Name] with [Service – Treatment or Funding] on [Date of Service]. Attached are the [Medical Bill or Financing Agreement] and signed lien agreement for your records.
Please reply to this email confirming that you have our lien on file.

Additionally, you can add a ‘Read Receipt’ to the email you send, as well as send a confirmation by certified mail.

It may sound excessive, but effective lien management is an essential part of the personal injury case process. Best practices are not complicated, and diligence and good communication go a long way.

The Opportunity with Letters of Protection for Medical Providers

By | Blog

In our experience, doctors wish to provide high quality medical care to as many patients as possible.  Worrying about contracts, reimbursement rates and collections from a variety of payor sources is not the reason most doctors went to medical school, yet the revenue cycle management side of the business is essential to operating a successful practice.

Most revenue cycle management companies are good at contracting with a variety of payor sources and collecting patient payables but for patients who have been injured in an accident – through no fault of their own – and who do not have adequate healthcare coverage but who need medical attention, these bills are more complex but can be collected through letters of protection (LOP) utilizing third party servicing platforms like

For doctors providing care to personal injury victims, LOPs are an alternate option of payment.  Seeing patients regardless of payor source is an honorable pursuit.   LOPs are signed by both the patient and attorney representing the patient at the time of treatment. They simply state that upon resolution of the personal injury case, the balance of the medical bill(s) will be paid through the attorney escrow account when the case is resolved. In return, the provider agrees to provide treatment.

In essence, LOPs allow personal injury victims to receive the care they need – and that they otherwise would not have been able to receive – while also protecting the healthcare practices providing the care.

The Key Issues Medical Providers Face with Letters of Protection – And their Solutions

In today’s environment, LOPs are managed by medical providers, law firms or sold outright to medical funding companies, like Cherokee Medical Funding but this is not the wave of the future.  Insurance defense and various state legislatures are increasingly scrutinizing the traditional sale of medical receivables passing legislature prohibiting or seriously limiting this option. Gain Servicing is the future of medical lien servicing for uninsured and underinsured patients in need of medical care.  Gain provides an independent, SaaS based, AI enhanced, third party servicing platform to separate medical providers from the potential for conflict of interest, biased medical opinions and financial interest in the outcome of the case while servicing these receivables rather than purchasing them.  This allows for patients to receive needed medical care without the undo pressure that a traditional medical funding can put on the case settlement.  By servicing them on behalf of medical providers. Gain also provides a variety of financial solutions that maintain the doctor’s independence.

One issue for medical providers holding their own patient LOPs is that insurance defense counsels have made them one of their primary targets. Some of their common tactics include:

  • Operating a “playbook” designed to trap providers into appearing that there is a conflict of interest, that their medical opinion is biased, and that they are “investors” in these lawsuits.
  • Examining communication, including text messages, emails, phone logs and more, between providers and attorneys for communication regarding insurance policy limits, case values, ongoing case updates, settlement influence, negotiations, case involvement, and insurance opt-out requirements.
  • Looking for the separation of patient and clinical records and bringing in forensic medical billing experts to search for dual charge masters, varied billing, upcoding, charges that are beyond usual and customary, and more.

Here are some of the additional challenges medical providers servicing LOPs face, and the solutions gain servicing has created to address them:


  • Challenge: Practice management systems (PMSs) and revenue cycle management (RCM) platforms are not designed to track or manage LOPs, including referral source analysis. As a result, medical providers are often forced to create manual, time-consuming workarounds to track LOPs. In our experience, it is extremely difficult to avoid instances that result in write-offs when using these types of workarounds. Additionally, there is often a large volume of receivables without due dates.
  • Solution: gain servicing has designed proprietary software to automate and optimize the tracking of personal injury lawsuits tied to LOPs. Capabilities include notice of service, all needed filings, automated case updates, automated LOP tracking, referral source analysis, revenue optimization, reporting and analytics, and additional business intelligence to provide real-time status updates.


  • Challenge: For medical providers, rather than having a single point of contact or payor source, personal injury patients require complex communications with case managers, paralegals, the patient, attorneys and third-party liability carriers.  The management of these communications alone is not easy and is not readily available in current RCM, EMR or Billing Systems.  Failure in these areas leads to higher charge-offs.
  • Solution: It is essential for holders of LOPs to be in constant communication with attorneys, paralegals, and case managers to obtain underwriting information, assess case characteristics, receive case updates, negotiate settlement amounts, and perform collection activities. Liability carriers also need to be contacted in certain circumstances. Gain Servicing’s practice is designed around and specializes in these critical forms of LOP communication needs.

Insurance Defense:

  • Challenge: Insurance defense attorneys are attacking medical providers who hold LOPs and communicate with attorneys to attempt to show biased though the discovery of case communication between attorneys and doctors, the exchange of case estimates, policy limits and more. They often claim charges are excessive and that professional opinions are biased. This also leads to high costs for medical providers due to legal responses, objections, discovery and longer depositions. Medical providers, PMS and RCM platforms are not equipped to object to discovery requests or segment any of this information to avoid these potential objections.
  • Solution: Maintaining healthcare provider integrity and unbiased medical opinions as well as eliminating the financial interest in the outcome of a case are all challenges gain servicing solves for medical providers.


  • Challenge: Various legislatures have attempted to eliminate traditional medical funding in order to then force healthcare providers to hold liens and then have insurance defense attorneys attempt to show the bias outlined above.
  • Solution: Nationwide lobbying efforts are key to maintaining patient access to quality medical care. Cherokee Legal Holdings and gain servicing are founding members of Americans for Patient Access (APA),, a best practices organization committed to maintaining access to quality medical care for all patients regardless of payor source. Lien Servicing is the future and gain is the industry leader.

Letter of Protection Servicing Options for Medical Providers

There are several servicing options that gain servicing has evolved to address the most pressing needs for medical providers when it comes to LOPs.

In summary, LOPs serve a critical need for personal injury victims. They are traditionally serviced in-house by a medical provider, through a law firm, or sold to a medical funding company. Each of these options are outdated, similar to the situation Kodak and Polaroid faced when they knew that digital film was coming but they chose not to cannibalize their own businesses and instead went bankrupt.  At gain servicing, we see the future and are willing to cannibalize our own business for the benefit of patients, doctors and the legal community. It is paramount that the victims in these cases have access to the medical care they need. A trusted outsourced partner can allow you, the provider, to focus on treating more patients and getting great outcomes for them. Our holistic approach to servicing, including technology, people, and processes, is proven to deliver higher reimbursements, at a lower cost. Let us help you, help your patients.

If you are a medical provider with questions about letter of protection servicing, please get in touch with us. We would love to discuss your practice, LOP challenges and our solutions.

Inc. Magazine Unveils 2020 Inc. 5000, Cherokee Legal Holdings Named One of America’s Fastest-Growing Private Companies

By | Blog, Press Releases

Cherokee Legal Holdings Ranked No. 3009 on the 2020 Inc. 5000 with Three-Year Sales Growth of 131%

Atlanta – August 17, 2020 – Inc. Magazine has ranked Cherokee Legal Holdings (“Cherokee”), a full-service direct legal and medical services company, providing financial assistance for plaintiffs, payment for medical care and the servicing of third-party, torte action receivables for medical providers, number 3009 on the 2020 Inc. 5000 list, an exclusive ranking of the nation’s fastest-growing private companies.

This is Cherokee’s first year applying for and making the Inc. 5000 list.

“Given the outbreak of COVID-19, this year has proven especially challenging for businesses around the country and around the world,” said Cherokee CEO Reid Zeising. “Commemorating where we are with a spot on the Inc. 5000 is monumental, and it gives us hope and motivation to continue fighting for what our company was built on – equality and justice for all. With the pandemic, our revenue cycle management and services to healthcare providers along with financial assistance to plaintiffs have proven invaluable as providers search for ways to optimize operating efficiencies and plaintiff needs expand. As a result, we have seen an acceleration in what were already tremendous growth rates.”

Inc. is reporting that not only have the companies on the 2020 Inc. 5000 been very competitive within their markets, but the list as a whole shows staggering growth compared with prior lists as well. The 2020 Inc. 5000 achieved an incredible three-year average growth of over 500 percent, and a median rate of 165 percent. The Inc. 5000’s aggregate revenue was $209 billion in 2019, accounting for over 1 million jobs over the past three years.

Complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, region, and other criteria, can be found at The top 500 companies are also being featured in the September issue of Inc., available on newsstands August 12. Cherokee’s profile can be viewed at

“The companies on this year’s Inc. 5000 come from nearly every realm of business,” says Inc. editor-in-chief Scott Omelianuk. “From health and software to media and hospitality, the 2020 list proves that no matter the sector, incredible growth is based on the foundations of tenacity and opportunism.”

The annual Inc. 5000 event honoring the companies on the list will be held virtually October 23-27, 2020.

“Growing well over 100 percent would have never been possible with the tremendous efforts of the Cherokee team,” said Zeising. “This recognition is for them.”

Cherokee Legal Holdings Announces the Launch of Gain Servicing, Relief for Healthcare Practices Amidst COVID-19

By | Blog, Press Releases

Atlanta, Georgia – Today, Cherokee Legal Holdings (“Cherokee”), a full-service direct legal and medical services company, providing financial assistance for plaintiffs, payment for medical care and the servicing of third-party, torte action receivables for medical providers, announced the launch of gain servicing, a wholly owned subsidiary of Cherokee.

Cherokee, a founding member of Americans for Patient Access (APA) advocating for patient care regardless of health insurance coverage, was founded in 2010 and is one of the fastest growing funding companies in the U.S. In 2019, Cherokee piloted an artificial intelligence initiative to increase patient data analysis and accelerate the financial returns produced for healthcare practices. Gain servicing now offers these services to healthcare providers directly.

Gain servicing provides the management of certain third-party liability claims including Letters of Protection (LOPs) and the management of third-party liens on behalf of healthcare practices, which enables doctors to focus less on their accounts receivables and more on treating patients, regardless of those patients’ medical coverage.

“Doctors are passionate about patients having access to proper treatment, whether they have health insurance or not. As a result, many practices treat uninsured and underinsured personal injury patients on an LOP. This is a ‘win’ for these patients who get needed medical treatment they may not otherwise receive. Meanwhile, treating patients on LOPs is financially hard on doctors. Many have to wait months and even years in the hopes they will get paid when the patient’s case settles. For these very situations, we have created gain servicing to manage these cases from inception to repayment,” said Cherokee CEO, Reid Zeising. “Amidst the COVID-19 outbreak, this service has proven especially critical to many practices that have seen elective procedures slow and may already be stretched thin financially.”

Gain servicing offers a package of technology, people and processes that have proven to deliver higher reimbursements at a lower cost without impacting patient referrals. Gain servicing’s proprietary platform uses machine learning to analyze case information, track LOPs and predict settlement values, thus granting access to needed medical treatment for plaintiffs in tens of thousands of underlying lawsuits. The comparative data simultaneously fuels the artificial intelligence (AI) engine that the gain servicing team then uses to optimize the repayment of rates for LOP cases.

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