The healthcare industry has seen its share of mergers and acquisitions over the last few years which has affected in large scale the way the medical field looks and conducts business. Likewise, the changing landscape of the collection industry is producing larger regional and national companies that have survived an industry-wide M&A wave as well as the tightening of rules and regulations by increasing their investments in compliance, infrastructure, technology, analytics, training of staff and process improvement. As this process continues, smaller, localized “mom and pops,” and even some medium-sized regional agencies, have had trouble competing with these leaner, more diversified operations.