Missed appointments occur occasionally, if not daily, at some practices. A missed appointment is potentially lost revenue and requires follow-up with the patient to reschedule to get them seen. Sometimes, a missed appointment happens with no notice to the patient. Most common are those with an emergency or urgent family matter requiring them to cancel or not show up for their scheduled appointment. Which missed appointments do you bill for, and which do you not bill for?
Billing Medicare for Missed Appointments
The Centers for Medicare and Medicaid Services (CMS) does allow physicians and suppliers to charge for missed appointments, provided they do not discriminate against Medicare beneficiaries and charge all patients for missed appointments. The charge is not for the lost revenue or the service itself based on the scheduled appointment type but for a missed business opportunity.
What to include in a missed appointment policy
Patients must be given proper notice before charging for a missed appointment. Notice should be in writing and separate from the consent form. A copy of the signed notification should be retained in the patient’s medical record.
Patients should not be charged for missed appointments when the appointment is missed due to circumstances outside their control. For example, the patient received a call from their child’s school and had to attend to the matter, a traffic delay caused by an unknown construction or traffic incident. These are a couple of examples where a patient or their beneficiary may not have the opportunity to comply with the practice’s cancellation notice. Typically, the notice period is at least 24 hours in advance.
What to charge for an appointment cancelation
Generally, the cancelation charge ranges between $25-$50, which is billable directly to the patient. Some state laws do prohibit billing for canceled appointments. Third-party liability insurance carriers, such as Workers’ Compensation, may have provisions that allow for billing a missed appointment under certain circumstances. For example, Michigan allows for billing a missed appointment for Workers’ Compensation if the carrier or employer fails to cancel an appointment not less than 72 hours in advance and the provider cannot fill the appointment time. (MICH. ADMIN. CODE R 418.10112).
In-network provider contract
Some provider agreements may prohibit billing their beneficiaries for no-show office visits. Generally, provider agreements by way of incorporation include the provider manuals and payment policies, which an in-network provider is subject to. Many have missed appointment policies. Some provider manuals address missed appointments under their care management areas to assist providers when a patient has noncompliant behavior, such as multiple missed appointments.
How to reduce missed appointments
Beyond having a well-publicized policy and proper notice given to patients is simply trying to avoid or reduce missed appointments altogether. Appointment reminders are allowed under HIPAA, and if authorization is given, these reminders can be provided by text messaging and calling the patient. You must comply with specific requirements regarding appointment reminders to be aware of.