A precollections letter is the final warning that a patient receives before a delinquent account is turned over for formal action by a collections agency. Many practices send this letter themselves, on their own letterhead, but recently more practices have realized that patients are more likely to pay immediately when they receive a letter from a collections agency, rather than from a medical office. So, since a medical office can't misrepresent itself as a collections agency, many are hiring real collectors to send this letter, paying only $1 or so if the patient pays right up. The practice doesn't start to pay the standard commission (typically 20 percent to 35 percent), until the account goes into the regular collections process.