Why Managing TPL Internally Isn’t the Question Anymore
For many hospitals and health systems, managing Third-Party Liability (TPL) recovery internally seems like a logical and cost-effective choice. Existing revenue cycle teams already handle eligibility, billing, denials, and accounts receivable, making TPL appear to be a natural extension of their responsibilities.
As staffing shortages, payer complexity, and financial pressures continue to challenge healthcare organizations, leaders are increasingly evaluating whether their current TPL strategy is maximizing every reimbursement opportunity.1
TPL Requires a Different Skill Set
TPL claims differ significantly from traditional insurance claims. They often involve motor vehicle accidents, liability carriers, coordination of benefits, settlement monitoring, and extensive documentation.
Unlike standard claims, TPL accounts frequently require detailed investigations, liability verification, and ongoing follow-up that can extend for months. These activities can be difficult to prioritize amid ongoing healthcare workforce pressures and resource constraints.2
The Risk of Incomplete Recovery
Most hospitals recover some TPL revenue in-house, but maximizing recovery can be challenging amid competing revenue cycle priorities. Limited resources can make it difficult to consistently identify, investigate, and pursue every eligible reimbursement opportunity through final resolution.
At the same time, revenue cycle leaders continue to face staffing constraints and increasing payer challenges. According to the HFMA–Guidehouse 2024 Revenue Cycle Management Report, both remain among the top concerns affecting revenue cycle performance.1
Why Organizations Are Exploring Specialized Support
Healthcare organizations continue to face workforce shortages, reimbursement challenges, and rising operational costs. HFMA–Guidehouse research found that outsourcing remains a common strategy for addressing staffing constraints and supporting revenue cycle performance.¹
At the same time, increasing claims denials and capacity constraints are placing additional pressure on revenue cycle teams, making it more difficult to manage complex reimbursement opportunities effectively.³
As hospitals work to strengthen financial performance amid ongoing economic and workforce pressures, some organizations are supplementing internal resources with specialized support to help ensure revenue recovery efforts receive the attention they require.⁴
The Better Question
Rather than asking, “Can we manage TPL internally?” hospital leaders may benefit from asking: “Is our current approach delivering full recovery while making the best use of our limited resources?”
As reimbursement pressures and operating costs continue to rise, healthcare organizations are looking for opportunities to strengthen financial performance across the revenue cycle.4 In that environment, optimizing TPL recovery can help improve cash collections, reduce revenue leakage, and strengthen financial performance without adding pressure to already stretched internal teams.
About Elevate Patient Financial Solutions®
For more than 45 years, ElevatePFS has delivered exceptional revenue cycle management services to healthcare providers nationwide. Its comprehensive solutions, including Eligibility and Enrollment, Revenue Cycle Analytics, Complex Claims, Denials Management, Extended Business Office Engagements, and Self-Pay/Early Out Services, drive optimal financial performance while improving the patient experience.
With a 95% client retention rate, ElevatePFS is a trusted, proven partner for sustainable revenue recovery and patient-centered financial engagement. ElevatePFS has earned the HFMA Peer Review designation for over 15 years, achieved Great Place to Work® certification for four consecutive years, received the 2025 Best in KLAS recognition for Eligibility and was named a #1-rated vendor for self-pay, charity care, Medicaid screening and eligibility enrollment services in the 2026 Black Book Research rankings.
Sources
- HFMA–Guidehouse: 2024 Revenue Cycle Management Report,
https://guidehouse.com/-/media/new-library/industries/health/documents/2024/2024-revenue-cycle-management-report-guidehouse.ashx - KFF: The Health Care Workforce Under Pressure: Strikes, Shortages, and Staffing Requirements,
https://www.kff.org/event/nov-16-web-event-the-health-care-workforce/ - Kaufman Hall: 2023 State of Healthcare Performance Improvement: Signs of Stabilization Emerge, https://www.kaufmanhall.com/sites/default/files/2023-10/KH-Report_2023-State-Healthcare-Performance-Improvement.pdf
- American Hospital Association: America's Hospitals and Health Systems Continue to Face Escalating Operational Costs and Economic Pressures,
https://www.aha.org/system/files/media/file/2024/05/Americas-Hospitals-and-Health-Systems-Continue-to-Face-Escalating-Operational-Costs-and-Economic-Pressures.pdf