Ophthalmology and Optometry Coding Alert

Tip: Make sure your carriers don't frown on payment penalties Every office has them -- patients who schedule an appointment and never show up. So how can you code for an office visit if the patient never shows up? Well, you can't -- but you can take steps to minimize lost reimbursement for "no-show" patients. Use these field-tested strategies on missed appointments. Start by Contacting Patients  Making reminder phone calls prior to appointments and follow-up calls to patients who miss an appointment are good steps toward lessening the reimbursement woes caused by no shows.

Pointer #1: Look into current technology that allows you to make automated telephone reminders. Or, if you can, collect e-mail addresses and send e-mail reminders.

Pointer #2: Many practices contact patients after they have missed two or three appointments, telling them that they will be charged a fee for another missed appointment or that they could even be dismissed from the practice.

"Our new policy is that patients are allowed three no- shows; after that, they are terminated from the practice," says Christopher Felthauser, CPC, CPC-H, ACS-OH, ACS-OR, PMCC, medical coding instructor for Orion Medical Services in Eugene, Ore.

Important: Make sure patients are aware of your policy. Putting it in writing in your new patient materials is a good way to ensure patients see the policy and post it in a prominent place in the waiting room. When his practice changed its no-show policy, Felthauser says, they updated the practice's financial policy to show the new information and notified all patients of the change.

Best practice: Have a written policy and a sheet that the patient signs and gets a copy of acknowledging they've reviewed the policy, says Quinten A. Buechner, MS, MDiv, ACS-FP/GI/PEDS, CPC, president of ProActive Consultants LLC in Cumberland, Wis. "For those very few who do not want to sign, the reception staff enters the date on the form with a note 'Patient given copy of form but would not sign.' These forms then go in the record."

In your policy, include information such as: 

• The patient will need to notify you that he is not going to show

• Whether you'll charge a fee

If you are going to charge a fee, what that fee is. Charge for Repeat No-Shows If a patient misses an appointment, you can charge the patient a no-show fee.

Caution: Be sure you check with your carriers to see if they have a problem with you charging a no-show fee. "We tried instituting a no-show penalty payment. However, many of your contracted insurance companies may frown on that -- especially Medicaid. Our Medicaid population seems to have the highest number of no-shows. So it really didn't do any good," Felthauser says.

Note: "Only Medicaid [...]