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Billing for failed appointments

  1. #1
    Question Billing for failed appointments
    Medical Coding Books
    Can we charge a pt our full fee for a failed appointment?
    MonaLisa LaBonte CPC

  2. #2
    In the Feb 2000 Medicare Bulletin for the below states, this was located: Medicare Part B Medical Bulletins IL,MI,WI BILLING FOR FAILURE TO KEEP AN APPOINTMENT Fraud committed against the Medicare program may be prosecuted under various provisions of the United States Code and could result in imposition of restitution, fines, and imprisonment. In addition, there is also a range of administrative sanctions and civil monetary penalties that may be imposed. Attempts to defraud the Medicare program may take a variety of forms. According to §14001 of the Medicare Carrier' s Manual (MCM), billing the Medicare program for services or supplies that were not provided (including billing services that were not actually provided because the patients FAILED to keep their APPOINTMENTs), may be considered fraud. In its Program Integrity Manual, HCFA notes that Medicare fraud may take the form of providers or suppliers who bill Medicare for APPOINTMENTs the patient fails to keep (Chapter 3, §3.1). It is important to note that although a provider may not bill the Medicare program for “no SHOWs” because no covered service was rendered, the beneficiary may be billed. Such billing charges do not relate to any service covered under the Medicare statute so neither HCFA nor WPS may interfere with the provider's billing policy for “no SHOWs.” To avoid possible discrimination or civil rights violation, however, the provider should be certain that any “no SHOW” billing policy is


  3. #3
    this is not a Medicare pt and we are in Ma so would that make a difference?
    MonaLisa LaBonte CPC

  4. #4
    North Carolina

    According to Chapter 12, section 30.3.13 of the Medicare Claims Processing Manual, which is attached to CR5613, CMS policy allows physicians, providers, and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments and the charges for Medicare and non-Medicare patient are the same. The charge for a missed appointment is not a charge for a service itself (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity. Therefore, if a physician's or supplier's missed appointment policy applies equally to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the physician or supplier from charging the Medicare patient directly.

  5. #5
    Milwaukee WI
    Default What level E/M
    Well, if the patient didn't show up how do you know what level E/M would have been charged?

    Most physicians that I know of have a standard "no show" fee that is assessed to all patients for failure to cancel within 24 hours of scheduled appointment. It might be different for a new patient vs an established patient (because you usually block out MORE appointment time for a new patient), but I would have a written policy, I would have it posted at the front desk, and I would instruct my scheduling personnel to verbally inform all patients at the time the appointment is scheduled of the policy.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 11-03-2009 at 04:34 PM.

  6. Default Billing for no-show
    All offices should have a policy that is available to patients stating what your "no show" fee is and how it will be applied when a patient fails to cancel their scheduled appointment.

    You cannot bill patients for a "no-show" unless the patient was aware of your policy and as it was stated above, it should be applied to all patients in the same manner if you're going to charge for missed appointments.

    Written policies outlining what you expect is a good tool for communication with patients. They know what to expect from you and then you can always point to your policy and cite it when an issue arises.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    AMBACode Coding Software
    2015 AMBA National Medical Billing Conference

  7. #7
    I'm curious to the terminology you are using. What does "failed" mean to you? I'm wondering if maybe the patient walked out at some point during the visit instead of just no showing. If that was the case you would bill based on what you did. In the case of a new patient where 3 of 3 are required you would have to use 99499. Now, if they walked out before they were seen because they got tired of waiting I don't think you can charge anything, at least I wouldn't.

    Laura, CPC, CEMC

  8. Default Failed Appointment?
    Okay we have patients that check in for there Appointment but when there name is called there are not here..

    1 what would be the POV for this visit ?
    2 What would be the CPT for this visit ?

    If any? I know we can not bill if they were not seen by the provider or nurse.
    So what and who would enter that info in the computer so at least we would have a record for it..?

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