Pulmonology Coding Alert

Weed out repeat offenders for best results.

With each passing year you may find it increasing tough to maintain your pulmonary practice’s income. Each incoming dollar is valuable with increasing payer scrutiny, changing reimbursement rates, and trouble collecting from patients who are struggling with their own financial issues. It adds insultto injury when patients miss appointments, adding to the cost of that lost time and revenue.

Missed appointments have an impact on your pulmonologist’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 pulmonologists’ time, bringing in income, and keeping patients healthy and happy.

#1: 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, and with your legal representatives to ensure the appropriateness of this practice.

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.

#2: 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

#3: 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 pulmonologists 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.Do not consider this if the procedures take place outside of the office at another location.

“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.

#4: Inform Your Patients

You should tell all your patients about the policy and have them sign the policy with their other annual financial documents. The purpose of a no-show policy is to notify your patients of a possible financial penalty for failure to cancel a scheduled appointment.

You need a written policy that includes information such as:

• If the patient needs to notify you that he is not going to show, and how long before the appointment you expect to be notified.
  
• Whether you’ll charge a fee, and how much that fee will be.
  

Example: Your policy could state something such as “Failure to give 24-hour notice of cancellation of an appointment or not showing up for an appointment can result in a charge of $25.00 on your account. This charge is non-covered by your insurance company and is your responsibility. Failure to pay a no-show fee will be treated the same as our policy on unpaid patient balances and will be subject to reporting to a collection agency if unpaid.”

“Ideally, the no-show policy should be incorporated in the practice’s financial policy and requires a patient signature agreeing to the policy,” Burgett says.

Ask your patients to sign and date the form when they first join your practice, as they would do when they initially sign your privacy or financial policies. Implementation of this policy for established patients requires notification and public posting in the practice for a period of time prior to implementation.

“If you’re clear from the start as to what the expectations are of the patient, it’s helpful to have a kind of a contract with them,” Johnson says. “Whether a sign on the wall at sign-in, or a verbal reminder from the person setting the appointment, or a written form to be signed, it can help people know that how they behave as a patient can affect others at this same practice. This not only should include missed appointments but people who are habitually late.”

#5: Try to Stop No-Shows Before They Happen

Sending reminder notices or making appointment reminder phone calls can help alleviate some of your missed appointment concerns. Check to see if your electronic record systems will generate automatic phone or secure message via your patient portal with a detailed reminder 48 hours before the appointment.” with an email to send the patient to the patient portal’s secure messaging inbox.

“A well-placed reminder, such as the day/night before an appointment can help to make sure that patients come in at the right time,” Johnson explains. “It’s also a good idea because the patients feel like the physician really does care about who they are and about their health.”

Down side: In some cases, charging patients a no-show fee could have a negative impact on your patient relations and could result in negative public relations for your practice. Make sure your pulmonologists are on board with your policy and that the policy balances patient goodwill with good business strategy.

Be understanding: Not every missed appointment is the result of a poorly behaving patient. Emergencies, such as car accidents, do happen, so you need be somewhat flexible. If a patient misses an appointment because she is in the emergency room with her child, for example, you probably shouldn’t charge her.However, considering patient excuses on a case-by-case basis may negate the ability to implement a no-show policy if the payers require a universal approach to charging fees.

“A location in a city-like environment might find that patients may be challenged looking for open parking spaces,” Johnson says. “Look to see if the patient(s) is a chronic offender or if there’s a good reason. Bad things happen to good people, and if a patient is generally always on time and one time doesn’t show due to a pressing situation, it may not be good practice to penalize them for the no-show. When creating a policy, all these things should be considered.”