ARCPC9491
True Blue
I'm searching around for literature about Medicaid not allowing you to bill patients if they are no shows... and I can't seem to put my finger on it. I've seen it before... can anyone help? Thanks.
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Wiki Medicaid No Shows
- Thread starter ARCPC9491
- Start date
RebeccaWoodward*
True Blue
AR,
I can't remember if you're in NC or not.......
Missed Appointments
Missed appointments are considered by the Centers for Medicare and Medicaid Services (CMS) to be part of the provider's overall cost of doing business and, therefore, prohibits Medicaid providers from billing a
Medicaid recipient for a missed appointment.
http://www.dhhs.state.nc.us/dma/basicmed/Section3.pdf
Page 4
I can't remember if you're in NC or not.......
Missed Appointments
Missed appointments are considered by the Centers for Medicare and Medicaid Services (CMS) to be part of the provider's overall cost of doing business and, therefore, prohibits Medicaid providers from billing a
Medicaid recipient for a missed appointment.
http://www.dhhs.state.nc.us/dma/basicmed/Section3.pdf
Page 4
ARCPC9491
True Blue
ah ha! exactly what I was looking for.. thanks Rebecca! I'm in VA but I know the same applies.. just couldn't find it but that works! thanks!
jenndeshon
Networker
Here's a twist
Okay, let me throw this out there on this subject: If you can't charge Medicaid patients a no show fee, how does that affect the Medicare policy that says you can only charge a no show fee to their patients if you charge the same fee to ALL patients?
Just curious.
Thanks!
Jennifer, CPC
Okay, let me throw this out there on this subject: If you can't charge Medicaid patients a no show fee, how does that affect the Medicare policy that says you can only charge a no show fee to their patients if you charge the same fee to ALL patients?
Just curious.
Thanks!
Jennifer, CPC
RebeccaWoodward*
True Blue
Good question, Jennifer~
As you stated, Medicare does allow billing for "no shows"...following certain guidelines. As someone pointed out to me, Medicare implemented this policy in 2007. Our Medicaid, on the otherhand, is notorious for having "current" (OLD!!!!) manuals...some dating back to 1999.
AR~This may be a situation where you might want to foward Medicaid a copy of Medicare's "no show" policy if your office is considering charging Medicaid patients a "no show" fee. However, this particular manual is dated April 2009...so I doubt Medicaid will change their view on this.
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf
One more thing...I am hearing from other coders that their states currently have guidelines in place prohibiting providers billing Medicaid patients "no show" visits. I'm sure this probably has to do with the poverty level. Excerpt from Medicaid manual--->"However, since individuals and families who are Medicaid-eligible have incomes ranging from as low as 30% of the federal poverty level up to 200% of the federal poverty level, most do not have the financial means to pay for care"
As you stated, Medicare does allow billing for "no shows"...following certain guidelines. As someone pointed out to me, Medicare implemented this policy in 2007. Our Medicaid, on the otherhand, is notorious for having "current" (OLD!!!!) manuals...some dating back to 1999.
AR~This may be a situation where you might want to foward Medicaid a copy of Medicare's "no show" policy if your office is considering charging Medicaid patients a "no show" fee. However, this particular manual is dated April 2009...so I doubt Medicaid will change their view on this.
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf
One more thing...I am hearing from other coders that their states currently have guidelines in place prohibiting providers billing Medicaid patients "no show" visits. I'm sure this probably has to do with the poverty level. Excerpt from Medicaid manual--->"However, since individuals and families who are Medicaid-eligible have incomes ranging from as low as 30% of the federal poverty level up to 200% of the federal poverty level, most do not have the financial means to pay for care"
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ARCPC9491
True Blue
I interpret the Medicare policy to be that you cannot exclusively charge only Medicare patients for no shows. "Non-Medicare" I believe does not refer to Medicaid, but other insurers.
mousesmom2006
Guest
Keep diligent track of your No Show patients. Then discharge them for non-compliance.