Clarifying Copays

June 1, 2005

We are somewhat confused by the subject of copays. Eighty-five percent of our practice is generated in the hospital — either through consults or the emergency department — and we rarely see patients in the office until their follow-up. Are we ever allowed to collect a copay on a patient's follow-up visit?

Question: We are somewhat confused by the subject of copays. Eighty-five percent of our practice is generated in the hospital - either through consults or the emergency department - and we rarely see patients in the office until their follow-up. Are we ever allowed to collect a copay on a patient's follow-up visit?

Answer: You are correct that most patients you see - those that came to you from the hospital - do not owe you a copay when they come to your office for follow-up care.

Follow-up visits generally don't include copays.

Of course, you'll want to collect from anyone else - your other 15 percent of patients.