Cherokee Legal Holdings Ranks No. 83 on Inc. Magazine’s List of the Southeast Region’s Fastest-Growing Private Companies

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Inc. magazine today revealed that Gain is No. 83 on its third annual Inc. 5000 Regionals: Southeast list, the most prestigious ranking of the fastest-growing Southeast private companies, based in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Puerto Rico, South Carolina, and Tennessee. Born of the annual Inc. 5000 franchise, this regional list represents a unique look at the most successful companies within the Southeast economy’s most dynamic segment–its independent small businesses.

“We are thrilled to have made the Southeast Regional Inc. 5000 list, as this is where the bulk of our partners and clients are headquartered. We have also been honored on the national Inc. 5000 list three times,” said Gain CEO Reid Zeising. “It is humbling and rewarding to see our commitment to leveling the insurance playing field, with our SaaS-based AI-enhanced LOP servicing platform and suite of services, validated on such an exclusive list.”

The companies on this list show a remarkable rate of growth across all industries in the Southeast region. Between 2019 and 2021, these private companies had an average growth rate of 673 percent and, in 2021 alone, they added 25,844 jobs and nearly $7 billion to the Southeast region’s economy.

Complete results of the Inc. 5000 Regionals: Southeast, including company profiles and an interactive database that can be sorted by industry, metro area, and other criteria, can be found at

“This year’s Inc. 5000 Regional winners represent one of the most exceptional and exciting lists of America’s off-the-charts growth companies. They’re disrupters and job creators, and all delivered an outsize impact on the economy. Remember their names and follow their lead. These are the companies you’ll be hearing about for years to come,” said Scott Omelianuk, editor-in-chief of Inc. magazine.

Gain, which is actively rebranding from Cherokee Legal Holdings, has been honored with three Inc. 5000 designations. With 15,000 law firm partners and over 3,000 healthcare clients, Gain is well-positioned for continued growth. The company’s sole mission is to create a fairer insurance system for all by providing best-in-class services and solutions.

About Cherokee Legal Holdings, soon to be Gain
Gain is the fastest growing medical lien servicing and legal funding company in the United States. Gain’s innovative artificial intelligence (AI)-enabled SaaS-based platform provides Letter of Protection (LOP) servicing and collections to doctors. Additionally, Gain creates value for legal teams by streamlining processes and mitigating risk. To learn more, go to

More about Inc. and the Inc. 5000 Regionals

The 2023 Inc. 5000 Regionals are ranked according to percentage revenue growth when comparing 2019 and 2021. To qualify, companies must have been founded and generating revenue by March 31, 2019. They had to be U.S.-based, privately held, for-profit, and independent—not subsidiaries or divisions of other companies—as of December 31, 2021. (Since then, a number of companies on the list have gone public or been acquired.) The minimum revenue required for 2019 is $100,000; the minimum for 2021 is $1 million. As always, Inc. reserves the right to decline applicants for subjective reasons.

About Inc. Media
The world’s most trusted business-media brand, Inc. offers entrepreneurs the knowledge, tools, connections, and community to build great companies. Its award-winning multiplatform content reaches more than 50 million people each month across a variety of channels including websites, newsletters, social media, podcasts, and print. Its prestigious Inc. 5000 list, produced every year since 1982, analyzes company data to recognize the fastest-growing privately held businesses in the United States. The global recognition that comes with inclusion in the 5000 gives the founders of the best businesses an opportunity to engage with an exclusive community of their peers and the credibility that helps them drive sales and recruit talent.

The associated Inc. 5000 Conference is part of a highly acclaimed portfolio of bespoke events produced by Inc. For more information, visit

“It is humbling and rewarding to see our commitment to leveling the insurance playing field, with our SaaS-based AI-enhanced LOP servicing platform and suite of services, validated on such an exclusive list," said Gain CEO Reid Zeising.

Eliminate Status Update Calls with Portal from Cherokee Funding

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Are you tired of phone calls and emails from lenders asking for case status updates?  With the Gain Attorney Portal those frequent emails and phone calls can be a thing of the past.

The Gain Portal for attorneys makes case status updates a breeze as you go about your normal routine of requesting treatment for your clients, downloading documents, or getting an instant payoff request.  As soon as you log in the Gain Portal automatically shows and color-codes those cases for you which are in need of attention without having to pick up the phone or respond to an email, preventing those calls and emails from coming to you in the first place.

When you see a yellow, orange, or red case status appear all you need to do is click on that case status and select the new status…. And that’s it, you’re done!

You won’t receive any emails or calls about the case status because you’ve just provided everything you need to.  If the status on a case has not changed you can even select the same status to indicate there has been no change.

The Gain Portal is free and easy to use, and available to all personal injury attorneys and providers who want to make their jobs easier while making more money.  To request an account simply email and we’ll get you going.

Gain Servicing Portal

The Problem with Letters of Protection for Medical Providers

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As a medical provider your job is hardly done after providing treatment to someone. You then have to collect payment for your services – and this can be easier said than done, especially in personal injury cases.

In the ideal world, everyone would have health insurance to cover their medical needs. This, of course, is not the case. So for those who have been injured in an accident – at no fault of their own – and who do not have adequate healthcare coverage but who need medical attention, their bills can be covered by a letter of protection (LOP).

For medical providers providing care to personal injury victims, LOPs are an alternate option of payment. They are to encourage providers to give care. They also serve to protect the victim of personal injury cases and enable them to receive the care they need. Backed in-house by the medical provider, by the law firm representing the victim, or a third party like gain servicing, an LOP simply states that upon resolution of the personal injury case, the balance of the medical bill(s) will be paid when the case finalizes. 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 medical providers providing the care.

The Key Issues Medical Providers Face with Letters of Protection – And Solutions That Solve Them

LOPs can be managed by law firms, medical providers, or sold outright to medical funding companies, like Cherokee Legal Holdings, the parent company of gain servicing. Gain provides the option of buying the LOPs or servicing them on behalf of medical providers.

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 defense mechanisms include:

  • Questioning whether medical providers who service their own liens act as investors in litigation.
  • 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 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 profitability. 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 known or easily managed and tracked due dates.
  • Solution: gain servicing has designed proprietary software to automate and optimize the tracking of personal injury lawsuits tied to LOPs. Capabilities include referral source analysis, automated LOP tracking, revenue optimization, reporting and analytics, and additional business intelligence to provide real-time status updates.


  • Challenge: Medical providers often lump their LOPs in with general accounting and billing functions. There are no special processes or subject matter experts to help ensure LOPs are being managed properly.
  • Solution: It is essential for holders of LOPs to be in constant communication with attorneys, paralegals, and case managers to obtain underwriting information, 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: Medical providers, PMS and RCM platforms are not equipped to object to discovery requests or know when to enter into confidentiality agreements when discovery is limited.
  • 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: Medical providers, PMS and RCM solutions are not equipped to keep up with state-by-state legislative initiatives and legal requirements.
  • 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.

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. Our servicing options include:

Partial Advance LOP Servicing:

Partial Advance LOP Servicing is a unique service for medical providers to be able to satisfy their immediate cash flow needs. Gain servicing offers a partial payment upfront and then once a negotiated amount is collected, we then revenue share the remainder of collections with you, the provider.

Revenue Share LOP Servicing:

Revenue Share LOP Servicing is an outsourced service option for medical providers. All medical lien servicing is handled by gain servicing, freeing up medical providers from having an in-house team. Liens are owned by you, the provider, while servicing and collections is handled by our wholly owned gain servicing, LLC. Note: gain servicing collects a servicing fee similar to traditional RCM collection fees.

LOPs serve a critical need for personal injury victims. Whether serviced in-house by a medical provider, through a law firm, or though an outsourced medical funding company like gain servicing, 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, without impacting referrals. 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 services.

Why Healthcare Providers Should Never Hold Medical Liens

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Medical liens are a risk for healthcare providers to hold. Most doctors and hospitals avoid providing treatment on medical liens and instead opt for immediate payment by treating patients with insurance or who can pay out of pocket.

The problem with this, of course, is that nearly half (46%) of all Americans are uninsured or underinsured and most do not have enough in savings to pay out of pocket for medical treatment.

But, with a medical lien, a healthcare provider could wait years for a case to settle, and, after waiting, the patient could end up not receiving the settlement amount that was initially anticipated. When case values are lower than expected, this can result in healthcare providers having to reduce their medical bills and/or risk those bills going unpaid altogether.

More than that, if a healthcare provider provides treatment to a plaintiff in a personal injury case on a medical lien and then holds that lien within the practice, there is then a vested financial interest in the case settling and ultimately this can be viewed as a major conflict of interest.

One of the primary targets of insurance defense counsels is healthcare providers holding their own medical liens. Some of their common defense mechanisms include:

  • Questioning whether healthcare providers who service their own medical liens are acting as investors in litigation.
  • 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 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.

In short, in-house medical liens can wind up being a major headache for healthcare providers. Not to mention, medical lien management requires a lot of expertise, manpower and/or specialized software, extensive and proactive follow-up and negotiation.

Which is why, many providers turn to servicing companies to sell their medical liens.

The Benefits to Healthcare Providers of Third-Party Servicing Their Medical Liens

  • Outsourcing is more cost efficient
  • Outsourcing increases operating efficiencies
  • Outsourcing mitigates risk, including:
    • Insurance defense attacks
    • Discoverability – expensive discovery demands are reduced
    • Medical opinion bias
    • Financial interest bias
    • Billed charges
    • Third-party outsourcing solves for many and varied legislative risks
  • Healthcare providers make more money

Ultimately, medical liens require time, dedicated expert resources, due diligence and follow-up in order to be managed properly. The benefit of outsourcing medical liens to a third-party servicing company is that they bring all of these to your portfolio of lien receivables, which often results in more liens being collected on.

How Third-Party Servicing Works

Before treating a personal injury patient on a medical lien, it is important to have an understanding of the case value.

In short, when a healthcare provider partners with a servicing company, like Gain Servicing, the medical lien process works like this:

  • The healthcare provider determines if medical treatment is necessary and related to the accident.
  • The healthcare provider gives the servicing company a breakdown of fees for treatment to be approved.
  • The servicing company evaluates the underlying personal injury case to see if the case is viable to enter into a medical lien agreement with the patient and his or her attorney.
  • If the servicing company assesses the case and determines it is viable, the healthcare provider is paid for the cost of the treatment after treatment is provided to the personal injury patient.
  • The servicing company recoups funds at the conclusion of the personal injury case.

All of the risk associated with treating personal injury patients on medical liens is almost completely reduced by using a third-party servicing company. Not to mention, treating this population of personal injury patients on medical liens can result in a substantial increase in patient flow, especially as attorneys start to refer their clients to the practice for treatment. This, coupled with partnering with a servicing company that is efficient on collecting medical liens, can result in substantial cash flow and revenue for the healthcare provider.

Selling Letter of Protection Receivables and Medical Liens

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Healthcare providers who treat patients on a letter of protection (LOP) or medical lien often underestimate the true costs associated with providing services this way. And, some providers may assume that collecting a higher percentage of the bill charged means that their LOP and lien business is more profitable than commercial payers, i.e. health insurance companies. But this is not always the case.

Fact: 46 percent of Americans are uninsured or underinsured. Treating patients on an LOP or a lien enables providers to treat personal injury patients – 84.2 million of which are uninsured or underinsured. But, the business aspects of servicing the treatment of patients on LOPs and medical liens are more complex and costly than most realize.

One solution for providers is to sell their LOP receivables and medical liens.

What is a Medical Lien?

A lien is a document that states you, as the medical provider, will be paid from the proceeds of your patient’s personal injury case. The lien is signed by your patient and his or her attorney. The patient instructs the attorney to pay for your services out of the proceeds of their personal injury case settlement. The attorney signs, acknowledges instructions of his or her client and promises to repay you at the conclusion of the personal injury case. A lien is necessary in the event that there is no insurance to pay for medical services.

What is a Letter of Protection?

An LOP is very similar to a lien; it is a letter from the attorney requesting that you, the medical provider, treat the patient with payment deferred until the successful resolution of the personal injury claim. Sometimes the attorney will put the amount he or she is willing to repay you at the conclusion of the personal injury case. Therefore, you may not get paid for treatment you provide in excess of that amount.

How to Sell LOP Receivables and Medical Liens

If your practice already treats personal injury case patients, you likely have an existing portfolio of medical liens and LOPs against personal injury cases. Accepting medical lien or LOP cases is a necessary part of treating personal injury accident patients. There are many benefits to this, of course, which include the steady inflow of patients who you would not otherwise treat and the subsequent revenue that is generated by providing treatment to this population.

But, LOP and lien practice management has its challenges:

  • Staff must manage, track, collect and negotiate LOPs and liens
  • Services have been provided for which you hope to get paid on in the future
  • The practice loses value against inflation (as you are not charging interest on LOPs or liens)
  • In most circumstances, each personal injury case has not been evaluated to determine if there is a strong likelihood the case will bear a financial recovery, which means the practice may not get paid
  • Your practice is likely not trained or skilled to negotiate with lawyers, all of whom have a vested interest in reducing the LOP or lien

The solution to this is to present your portfolio of medical liens and LOPs for analysis to a servicing company, like Gain Servicing. The servicing company will do a full review and analysis of the portfolio and present you with a purchase offer. When the sale is complete, the practice will receive a lump sum of money, which can be infused back into the practice. Subsequently, the practice is also relieved of all risk associated with those medical liens and LOPs, and all of the angst and work associated with managing and collecting on them.

Another option is to sell individual lien or LOP cases as they occur, instead of selling them off in bulk. This increases revenues more immediately without any additional risk or cost. This is best when the practice treats a patient who has been involved in an accident where there is a pending claim for damages for the injuries sustained. When there is no insurance to pay for the necessary medical services caused by an accident, either treatment is not provided or you agree to perform the treatment on a lien or LOP against your patient’s personal injury case. Either scenario poses challenges for the practice:

  • Scenario 1: No treatment is given.
    • The patient is unable to get much needed treatment.
    • The practice is unable to generate the revenues which could have been generated from providing treatment.
  • Scenario 2: You treat the patient on a medical lien or LOP.
    • The practice does not know if the personal injury case is viable, which means payment may never be received.
    • If there is payment, it may not come for several years. This, in essence, functions as an interest-free loan, of which the practice loses money on due to inflation every year.
    • If there is payment, the practice will likely be asked to reduce the amount of the lien or LOP.
    • The practice must invest in time and money to track the status of all medical liens and LOPs.

Why Sell LOP Receivables and Medical Liens

The biggest benefits of selling LOP receivables and medical liens include:

  • Substantially increase revenues by providing medical services that otherwise may not have been provided.
  • Get paid immediately for the services provided.
  • Gain more patients when attorneys and other medical providers know they can refer the practice lien or LOP cases.
  • Reduce employee time spent billing, following up and tracking liens and LOPs and trying to collect on them.
  • Eliminate the risk of a case being lost or of the practice not getting paid.
  • No longer deal with lawyers negotiating liens down as cases settle.
  • Remove high risk case files that a servicing company evaluates and determines will likely not settle for the initially anticipated amount.
  • Strengthen trial testimony as the practice is able to testify that there is no financial interest in the outcome of the trial.

In short, if there is a viable personal injury case, a servicing company, like Gain Servicing, will work out an LOP or medical lien with the patient and his or her lawyer, wherein you, as the medical provider, will be paid for services rendered with no risk or cost to you. The servicing company will evaluate the underlying personal injury case to see if the case is viable to enter into a lien agreement or LOP with the patient and his or her attorney. If the servicing company feels the case is viable, the practice will be paid for the cost of the medical services. Whereby, the servicing company will get paid back at the conclusion of the personal injury case.

With a servicing company partner, the only thing the medical service provider has to do is determine if medical services are necessary and related to the accident. Once the servicing company is called and the medical service provider gives the servicing company a breakdown of fees for services to be approved, the servicing company will then determine if it is a viable case. If the case is approved, payment will be sent upon confirmation that medical services were rendered; and then they handle the rest.

Selling lien and LOP cases is a great solution for most medical providers. Not only does it increase immediate cash flow, but the practice is able to treat a new group of patients they might not otherwise have been able to provide services for. It’s a win, win, win – for the medical service provider, the personal injury patient and the servicing company.

Private Equity in Healthcare

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Private equity interest in healthcare is on the rise. According to Bain & Company, healthcare private equity activity in 2019 posted a very strong performance relative to the prior year. The total disclosed deal value reached $78.9 billion, the highest on record. And, interest is only continuing to mount, especially in a post-COVID-19 market.

Oftentimes, the private equity strategy in healthcare is to either combine multiple practices of the same type in order to dominate an entire market, or to create a large multi-specialty practice. Investors in the healthcare space are typically looking to get their money back within 3-5 years (Medical Economics).

The stakes are high, and any one poor financial decision could make or break a private equity firm’s strategy and results.

A Partner to Private Equity-Backed Medical Practices: Gain Servicing

Gain servicing, a Cherokee Legal Holdings company, is an AI-driven servicing and financing company specializing in letter of protection (LOP) solutions for healthcare providers and investors.

Unbeknownst to investors, LOPs can account for a significant amount of a medical practice’s outstanding accounts receivables.

Here is how LOPs work and how they end up as an aged accounts receivable:

  • For personal injury victims in need of medical care as a result of the accident they were involved in, and who do not have adequate healthcare coverage for the care they need, their bills can be covered by a letter of protection.
  • For medical providers providing care to personal injury victims, LOPs are essentially an assurance of payment. They are to encourage providers to give care without having to assume the risk of not being paid. LOPs also serve to protect the victim of personal injury cases from being sent to collections while their case is ongoing.
  • Backed in-house by the medical provider, by the law firm representing the victim, or a third party like gain servicing, an LOP simply states that upon resolution of the personal injury case, the remaining balance of the medical bill(s) will be paid when the case finalizes.
  • Because LOPs are backed by a personal injury case, traditional billing, accounts receivable and collections departments do not always know how best to handle these files. Simply put, medical practices are not equipped inhouse to successfully collect on letters of protection. No electronic health record system exists that appropriately captures personal injury case statuses or liens, and none have the third-party liability concept built into them. There is also no workflow or status option fit for personal injury cases, so a medical practice’s results are only as good as their manual follow-ups and what they are able to track in Excel.

Gain servicing manages LOPs on behalf of healthcare practices. It is a service built on a mix of technology, people and processes, and it is proven to deliver higher reimbursements, at a lower cost, without impacting referrals to the practice.

Here are some of gain servicing’s biggest deliverables to healthcare practices and their investors:

  • More LOP payouts: Gain servicing’s LOP Servicing results in fewer write-offs and greater paid-in-full accounts.
  • Eliminates avoidable losses: Gain servicing follows the lifecycle of unpaid LOPs by tracking the status of the lawsuit underlying each LOP and taking corrective action, if needed.
  • Access to the most advanced LOP platform in the world: Built on Salesforce, every gain servicing customer gets the advantages of the most advanced LOP servicing platform in the world.
  • Better attorney relationships and referrals: Attorneys prefer when providers use gain servicing because of the automated process, time savings and efficiency, yielding more referrals for the practice and thus revenue and earning opportunity.
  • Actionable business intelligence: Full reporting and analytics provide direct insight into how LOPs are performing and enable a better understanding of the overall revenue generated from LOPs.
  • Referral source analysis: gain servicing’s platform tracks every LOP from every referral source. This provides powerful insights into how each referral source reimburses LOPs over time and allows comparison across all referral sources.
  • System agnostic plug-in optionality: Providers who use gain servicing can continue using their existing practice management software while still gaining critical access to gain servicing’s LOP processing capabilities. Gain servicing has experience working with a variety of systems, including AdvancedMD, Allscripts, Athena Health, Azalea Health, Carecloud, Cerner, eClinicalWorks, eMDs, EMA Dermatology (Modernizing Medicine), OmniMD, Practice Expert and many others.
  • Private label options: Gain servicing offers private label options where all communications are performed under the provider’s name. The default option is: “Gain servicing on behalf of [Provider Name].”

Gain servicing provides servicing to both independent and private equity-backed healthcare practices. Private equity investors rarely want to tell providers how to manage their practice. Instead, they want to support business growth and profitability while enabling providers to do what they do best, provide quality care. Gain servicing enables the predictable cash flow, business intelligence and reporting capabilities both providers and private equity investors both enjoy.

How to Increase Cash Flow from Letters of Protection – cont’d

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How to Increase Cash Flow from Letters of Protection

Physicians and medical practice executives can find it difficult to manage cash flow, especially amidst the ongoing concerns surrounding COVID-19 and as elective surgeries and other lucrative procedures continue to be put on hold. Cash flow difficulties compound when medical services are provided to personal injury patients on a Letter of Protection (LOP) – when payment from settlement can take years to receive.

Many practices attempt to handle LOP account balances in-house but LOPs are challenging for staff as practice management systems are not equipped to handle the complexities surrounding LOPs, including necessary and proactive follow-up measures with attorneys.

The downside, of course, is that cash flow takes a hit when LOPs are not managed properly and go unpaid. Since an LOP states that you, the medical provider, are agreeing to await payment from future settlements awarded to the patient/attorney, you can expect anywhere from six months to seven years before the practice realizes this revenue. Also, at the time of payment there may be reduction requests if the financial outcome of the legal case was not as expected. This can pose a serious risk to your payment. In response, some medical offices retain a paralegal or develop an underwriting department to screen the personal injury cases prior to seeing patients, all of which can be time consuming, costly and still result in unpaid LOP account balances.


LOP Financing Options: Third-Party, Inhouse, Gain Servicing

Many practices sell their LOP account balances at a discount to lien financing, or medical funding, companies. This provides the practice with immediate cash flow and offloads the work of tracking, managing and collecting on LOPs – but it comes with a tradeoff. Not only does the practice give up control of the process but having a third-party manage your LOP accounts receivables (AR) can come at a severe cut in profit depending on the bid amount of the financing company on your AR balances.

But, if managed inhouse, medical providers lack options to increase revenue and decrease time between service and payment for personal injury treatments.

A viable alternative is to consider a data-driven financing partner, like Gain Servicing. Our technology platform is backed by artificial intelligence and data from thousands of personal injury cases – intelligence we are able to pass along to our medical partners, resulting in fewer write-offs and more paid-in-full LOP balances.

Additional, unique benefits of Gain Servicing:

  • Automated LOP tracking – no more manual processes or workarounds
  • Optimized revenues – our AI-powered platform enables us to compare balances and case data points to help you get a better return
  • Business intelligence – detailed reporting and analytics show you how well our system is doing for you
  • Referral source analysis – know exactly how patients are choosing your practice through the identification and tagging of attorney referrals
  • White label options – our team can act as badged resources for your practice while collecting on LOPs, creating a consistent patient and attorney experience with your practice

In the Gain Servicing model, you benefit from our tools and technology, experience, expertise and optimization of LOPs without the risk you had previously been assuming by treating personal injury patients on LOPs and not having the right systems, processes, procedures and people in place.


A Newfound, Viable Source of Revenue: LOPs

With a financing partner like Gain Servicing, practices can open their doors even wider to personal injury and workers’ compensation patients.

Marketing for these ‘types’ of patients is relatively simple. Begin first by letting physicians know that they can bring their personal injury and workers’ compensation patients who are uninsured or underinsured to your facility. Many orthopedic surgeons and pain management physicians are already treating or being approached by attorneys to treat these injured patients. You can also notify your local personal injury attorney offices or local litigation groups who legally represent potential patients of your willingness to accept their clients on a lien or LOP.


In Closing

Communication with patients and attorneys is an ongoing requirement when dealing with LOPs; otherwise, it is possible they may settle the case without paying your medical bill. A technology-driven, experienced financing company, like Gain Servicing, takes on the role of an entire collections department while additionally providing LOP-specific tools, expertise and processes. Namely, LOP receivables do accumulate and age well beyond 120 days, and if not working with a medical-legal funding company, like Gain Servicing, you will need to allocate valuable resources to keep up to date and track your LOP accounts.

When evaluating alternatives to expand your reimbursement portfolio, accepting personal injury and workers’ compensation patients on LOPs is a sound business decision and requires minimal investment to significantly increase patient volume. You can reasonably expect that by opening communication with local attorneys, you will see consistent patient referrals – especially if you partner with an expert like Gain Servicing and have an efficient process surrounding LOPs.

If your practice has already been treating patients on LOPs and you need to increase your cash flow now, seek an experienced partner to monetize that patient volume through lien purchasing or servicing. Gain Servicing has several different options available, and we can customize a solution that will result in the greatest return on investment for your practice.


More About Gain Servicing

Gain Servicing specializes in the financing and servicing of personal injury and workers’ compensation patient receivables.

Gain Servicing is a wholly owned subsidiary of Cherokee Legal Holdings, a medical-legal funding company headquartered in Atlanta, Georgia. For over 10 years, we have financed existing third-party liability accounts from patient care that has been provided at healthcare facilities and medical practices across the U.S. We provide the underwriting and up-front screening, as well as process the paperwork and conduct the necessary follow-ups with attorneys after procedures are complete. We pay medical providers for their patient care, assuming the risk while providing immediate cash flow to the practice. Our goal is to increase healthcare organizations’ cash flow now while seamlessly allowing providers to do what they do best – provide care to those in need.

Gain Servicing is the go-to solution for medical practices providing quality care to the injured, underinsured and uninsured.

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.