Patients have higher deductibles and co-payment requirements. Consequently, you’ve seen your self-pay account balances grow due to changes from the Affordable Care Act. You also know you are supposed to apply a “reasonable collection effort” to resolve these bills. Obviously, you need the cash. But what exactly does CMS mean when they say you need to use a “reasonable collection effort?” What are you supposed to do with those patients who cannot pay? Does the reasonable collection effort requirement mean you can’t write-off balances when a patient can’t afford to pay?

Click this video to quickly get the answers to your questions:

If you need to create a financial hardship policy for your organization, here are the Federal Poverty Guidelines for 2015 to get you started (published Federal Register, January 22, 2015):

Persons in Family/Household

Poverty Guideline

















Greater than 8

Add $4,160 for each additional person


Last, but not least, the link to info on the reasonable collection issue:

About the author:  Maggie Adams is the president of EMS Financial Services, with over 20 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. Check out our newest documentation training webinars and billing webinars on our website. Friend EMS Financial on Facebook, or for more info, contact Maggie directly at or visit