Last year I hired a collections company that is located down the road from us, but they do collections all over the U.S. This is how we do it:1st , when pts come in for first time, in the paperwork they must sign, it states that if account is sent for special handling, the pt/responsible party will be charged "A 35% service charge will apply to your account and any additional expenses or associated fees that are incurred in pursuit of this debt."2nd, once all invoices are sent, a final "special handling" letter with same information on it is sent along with another itemized bill with the 35% fee added.3rd, 15 days later it is sent to the collections company. when pt pays the agency, the % is already in the balance owed. So, we the provider gets our account paid in full along with the agency gets their money in full. ITS WONDERFUL Once it goes to the agency, all we do is wait every month to get a check from the agency and that is all I have to do.