Oncology & Hematology Coding Alert

Procedures and office visit are equally important.

Facing challenges to keep income flowing? Increasing payer scrutiny, changing reimbursement rates, and trouble collecting from patients who are struggling with their own financial issues may be your concern. Keep a tab on patients who are missing appointments as the cost of that lost time and revenue can quickly add up.

Missed appointments have an impact on your oncologist’s schedule or his availability to other patients, and can also pose a health risk to the patient. Review these no-show collection best practices to ensure your practice is maximizing your oncologists’ time, bringing in income, and keeping patients healthy and happy.

Bill the Patient, Not the Payer

Your first step in evaluating whether to charge a fee to patients who do not show up for appointments is to check with your payers. Medicare allows charging for no-shows as long as it is the office policy and done universally to all patients (except Medicaid, which doesn’t allow no-show fees).

“Verify with health plans,” says Charlene Endre-Burgett, MS, CMA (AAMA), CPC, CMSCS, administrator for North Scottsdale Family Medicine in Ariz. “Some states’ Medicaid programs do allow the practice to charge a no-show fee as long as it is charged to all patients. Arizona does have a policy for charging no-show fees to Medicaid patients (www.azahcccs.gov/commercial/Downloads/Copayments/CopayLetterProvidersRev4_withCharts.pdf).”

Your contract may give you scenarios of when you can, and can’t, bill for a no-show. For example, most payers will not allow you to charge a patient who cancelled an appointment more than 24 hours before the scheduled appointment time.

You should also check your state’s laws to see if there are any laws prohibiting you from billing for no-show visits.

Beware: If your contract allows you to bill for no-show visits, that doesn’t mean you can bill the payer. You need to bill the patient for the missed appointment.

Decide If No Shows Are a Problem

No show appointments cost the practice real dollars, experts say. But deciding what to do about it depends on your providers, your practice, and your location. In some cases, charging patients a fee when they miss a visit will help your practice offset the lost time and money the open appointment time cost.

“I would suggest that the office managers review the demographics as a whole to see if no-shows are a problem,” says Leslie Johnson, CPC, manager of coding, compliance & education at Somnia, Inc. in New Rochelle, NY. “Next would be to review current methods to see if they’re effective. If it’s necessary to establish a no-show policy where a patient might be charged a fee, it would be helpful to understand the patient population, location of the office and patient habits.”

Set Your Fee, and Keep It Fair

Your no-show policy should spell out exactly what fee you will charge for a missed appointment. Don’t limit your policy to just in-office appointments either, experts suggest. Since your oncologists likely perform procedures or surgeries, you should consider charging no-show fees for those as well. Many practices set one fee for an office visit and another, higher fee, for procedures.

“Depending on the type of practice, the no-show for procedures may be higher than for an office visit,” Burgett says. “In addition, if the procedure requires ordering of special medication or radioisotope (i.e. thallium), the policy may state that this needs to be prepaid and a refund will be given after the insurance company processes the claim.”

Some practices may charge a fixed amount of $25 or $50 for a missed office visit, which won’t cover the missed reimbursement. Others may charge the actual amount of the missed visit; for example, you may charge your normal fee for a surgical follow-up appointment.

“Determine a fair amount for your clientele,” Burgett stresses. “Be consistent. Treat everyone the same so there is no allegation of discrimination.”

Don’t miss: Once you decide to implement a no-show policy, your practice needs to decide how the process will work. Most practices allow patients one or two “freebies,” meaning that they excuse the first missed appointment and do not charge a fee. You should send a letter to the patient, however, reminding him of your practice’s policy on no shows.

Once you’ve sent a letter reminding the patient of the policy, you should consider charging a fee for additional missed appointments. Then, if the patient begins to consistently schedule and no-show, you have the right to discharge him as a patient after a few offenses.

Editor’s note: Read more about billing for no-show in the next issue of Oncology Coding Alert Vol16N6.