Nevada Medical Debt Collection Rules for Practices

Most confusion comes from reading an agency rule as a practice rule, or the reverse. This table shows who each rule binds.

The Hospital Transparency Act, AB 343, passed in 2025 and took effect January 1, 2026. Most coverage focused on hospital price lists. The part that reaches physician practices is now NRS 439B.2841.

Who is covered

The rule binds a "health care entity." Nevada defines that as any facility licensed under NRS Chapter 449 (hospitals, surgery centers, many clinics), a practitioner group practice, and other entities the health department adds by regulation. Two or more practitioners organized as a business entity are the core of a group practice.

A solo practitioner is not named in the definition. That can change by regulation, and the steps are good practice anyway, so we advise solo practices to follow them.

What you must give the patient

Before taking any action to collect a medical debt, or authorizing an agency or anyone else to do so, a covered practice must give the patient, in writing, electronically or through a patient portal:

• An easy-to-understand itemized statement of what the patient owes.
• The name, phone number and email of a person or office that can discuss the statement and change the debt, including reducing or cancelling it.
• The other disclosures listed in the statute.

In practice, a clean statement shows each date of service, a plain description and CPT code for each service, the charge, what insurance paid, each adjustment, and the patient's share. Pull insurance details from the EOB so the patient can match the two.

Receipts after payment

Within 30 days after a patient pays anything toward the debt, to you or to your agency, you must send an itemized receipt. Agency payments count, so your agency contract needs to report payments to you fast enough to meet the deadline.

Penalties

A patient can file a claim, and the state Bureau of Consumer Protection investigates. Violations are treated as deceptive trade practices under Nevada consumer law, and the Governor's Consumer Health Advocate helps patients file. Debt tied to a violation can end up reduced or cancelled.

SB 248 (2021) added NRS 649.366 to 649.368. These sections bind licensed collection agencies, not the practice. But your agency's mistakes land on your patients and your reputation, so you should know the rules.

The 60-day notification

At least 60 days before taking any action to collect a medical debt, the agency must mail the patient a notice naming:

1. The practice or facility that provided the care.
2. The date the debt arose.
3. The principal amount.
4. The agency's name.
5. That the debt was assigned to, or otherwise obtained by, the agency for collection.

The original law required certified mail. AB 223 (2023) removed that, so regular mail now works. Nevada regulations also prescribe wording that says the notice is not an FDCPA communication. In 2023, the Ninth Circuit upheld the law against an industry preemption challenge.

Payments during the window

A patient may still pay during the 60 days if they reach out first and the agency tells them no payment is due and nothing will be reported to credit bureaus in that window. A voluntary payment does not restart the statute of limitations, is not an admission, and waives no defense (NRS 649.367).

The lawsuit floor, 5% fee cap and confession-of-judgment ban

Under NRS 649.368, a collection agency may not:

• Sue on a medical debt whose principal is below the justice court small-claims limit in NRS 73.010 ($10,000 when the law took effect). Small claims court is still allowed.
• Charge more than 5% of the principal as a collection fee or attorney's fee.
• Take a confession of judgment or a power of attorney to confess judgment.

The last point matters. Legal aid lawyers in Southern Nevada reported patients signing confession-of-judgment forms they thought were payment plans. That practice is now banned for agencies collecting medical debt.

What to put in your agency contract

• Confirmation the agency is licensed in Nevada and sends compliant 60-day notices.
• Payment reporting to you within 7–10 days, so you can meet the 30-day receipt rule.
• No referral until you confirm the itemized statement went out.
• Fee terms that respect the 5% cap on what can be charged to the patient.
• Your approval before any lawsuit or credit reporting.

Hospitals face extra limits under NRS 449A.159. If the patient has health insurance or may qualify for Medicaid, CHIP or another public program, the hospital cannot pursue anything beyond the copay or deductible until it has billed that payer and received a decision.

Collection efforts and interest can start only 30 days after the hospital mails a bill showing the patient's final share, after insurance and discounts. Interest is capped at the prime rate at Nevada's largest bank plus 2%, reset each January 1 and July 1. No other fees are allowed, including collection fees, except costs and attorney's fees a court awards.

AB 343 adds a second hospital rule: a hospital out of compliance with Nevada's price-transparency requirements may not collect debt that accrued during that period. Hospitals pursuing injury recoveries should also see our guide to medical liens and letters of protection.

FDCPA and Regulation F. The federal Fair Debt Collection Practices Act covers third-party collectors. A practice collecting its own accounts in its own name is generally outside it. Use a different name on letters, though, and you may be treated as a debt collector. Your agency must follow Regulation F, including its call-frequency limits and validation notice.

No Surprises Act. For uninsured and self-pay patients, you must give a good faith estimate for scheduled care. If the final bill beats the estimate by $400 or more, the patient can start federal patient-provider dispute resolution. Collect against an inflated bill and you invite that dispute.

Medicaid. A provider that accepts a Nevada Medicaid patient must take Medicaid's payment as payment in full for covered services (42 C.F.R. 447.15). Sending a Medicaid member's covered balance to collections is a violation, and state Medicaid staff have told reporters it does happen.

Nonprofit hospitals. Tax-exempt hospitals must also follow IRS section 501(r): a written financial assistance policy, a 120-day notice period from the first post-discharge statement, and 30 days' notice before extraordinary collection actions such as lawsuits or credit reporting.

Two changes that many Nevada articles still describe as law never took effect.

The CFPB finalized a rule in January 2025 to keep medical debt off credit reports. A federal court in Texas vacated it on July 11, 2025, finding it exceeded the agency's authority under the FCRA.

In Nevada, AB 204 would have banned providers and agencies from reporting medical debt and limited extraordinary collection actions. It passed the Legislature but Governor Lombardo vetoed it on June 10, 2025.

So medical debt can still be reported in Nevada, subject to the 60-day window, AB 343's limits on noncompliant hospitals, and the national credit bureaus' own policies. Those policies exclude paid medical collections and medical collections under $500 from reports. Reporting is a blunt tool; most practices recover more with statements, payment plans and early financial-assistance screening.

Nevada's general limitations periods under NRS 11.190 apply: six years on a written contract, such as a signed financial responsibility form, and four years on an open account or oral agreement. Which one applies depends on your intake paperwork. A payment made during the agency's 60-day window does not restart the clock.

This sequence satisfies Nevada and federal rules for a typical outpatient group practice. It is the backbone of how a patient billing service should run.

1. 1

   At intake

   Verify coverage, screen for Medicaid eligibility, and give a good faith estimate to uninsured or self-pay patients.

2. 2

   After adjudication

   Post the EOB and bill only the patient's share. Never bill a Medicaid member for covered services.

3. 3

   First statement

   Send an itemized statement that meets NRS 439B.2841, with a named contact who can adjust the balance.

4. 4

   Statement cycle

   Two or three statements at 30-day intervals, each offering a payment plan and financial assistance.

5. 5

   Pre-referral check

   Confirm the itemized statement went out, the balance is correct, and no dispute or assistance application is open.

6. 6

   Referral

   Send to a Nevada-licensed agency under a contract that covers the 60-day notice, fee cap and payment reporting.

7. 7

   Payments

   Send an itemized receipt within 30 days of every payment, including those made to the agency.

8. 8

   Escalation

   Approve any lawsuit or credit reporting individually, and watch the limitations date.

If you want this run for you, from statements to agency handoff, see our patient billing service.

This article is general information about Nevada law as of October 2026, not legal advice. Talk to a Nevada-licensed attorney about your practice's specific policies.