The Billing Corner

What Are the State Requirements for Co-Pays for Billable Visits?

What Are the State Requirements for Co-pays for Billable Visits?

Q: What are the state requirements to collect co-pays for billable visits, or at least make a good faith effort?

A: Essentially it’s up to the centers to develop policies regarding whether or not to collect patient balances.  The mandate piece is on the insurance carrier side.  If you are contracted with a plan and there is a  cost sharing component for the patient, you are obligated to attempt to collect from the patient, because of your contractual agreement.  However, it is up to your discretion on your collection attempt process.  There isn’t a mandate that we are aware of, and the information we published in our newsletter came directly from the State.

If you’d like further clarification, please contact SCHA-MI’s Billing Department.

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