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Medicaid No Shows

  1. #1
    Default Medicaid No Shows
    Exam Training Packages
    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.

  2. #2
    Location
    North Carolina
    Posts
    3,126
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    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

  3. #3
    Default
    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!

  4. #4
    Default 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

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    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/MLNMattersArt...ads/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"
    Last edited by RebeccaWoodward*; 04-23-2009 at 09:29 AM.

  6. #6
    Default
    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.

  7. #7
    Default
    Quote Originally Posted by ARCPC9491 View Post
    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.
    Keep diligent track of your No Show patients. Then discharge them for non-compliance.

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