Medicare Authorizes Missed Appointment Charges

It is increasingly common for physicians to charge their patients a fee for missed appointments. For example, approximately 31% of MTBC’s clients routinely charge a missed appointment fee. Most of these providers charge approximately $25, while others charge as little as $15 or as much as $100 per missed appointment1.

Until recently, there has been some uncertainty regarding whether a provider is permitted to charge a missed appointment fee to Medicare patients in view of Medicare’s assignment and limiting charge regulations. However, earlier this week, the Center for Medicare and Medicaid Services (“CMS”) explained the following:

CMS’s policy is to allow physicians 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.

See, CMS Manual System, Pub. 100-04 Medicare Claims Processing, Transmittal 1279 (October 1, 2007).

The missed appointment charge is not a fee for health care services rendered, but rather, as CMS explains, it is a “charge for missed business opportunity.” This is important because providers (whether participating or non-participating) are only permitted to directly charge Medicare/Medicaid patients specified cost-sharing amounts for health care services. For instance, balance billing is not permitted because, in accepting Medicare/Medicaid’s payment, a provider has agreed not to charge any other amount directly to his or her patient other than the specified cost-sharing amount. If the missed appointment charge was classified as a fee for service, a provider would not be permitted to pass it on directly to the patient; however, since it is classified as reimbursement for missed business opportunities, it may be charged to an offending patient.

If you are considering implementing a missed appointment charge, you should consider the following:

  1. You can charge a patient for a missed appointment, but this charge is not reimbursable; therefore, do not waste your time submitting a claim to Medicare or Medicaid because it will be denied.
  2. You cannot charge one fee to Medicaid/Medicare patients, while charging a different fee (or no fee) to self-pay/commercial payer patients. Such unequal treatment violates the Medicare and Medicaid statutes and regulations.
  3. It is a good practice to have new patients sign and acknowledge your office’s policy regarding missed appointment charges. This will help eliminate any confusion if your patients balk at paying your fee.
  4. From a business standpoint, it makes sense to build flexibility into your missed appointment charge. For example, many MTBC clients give their patients one ‘free’ missed appointment. The underlying rationale is obvious: Most patients become (unjustifiably) upset when they receive a statement for a missed appointment, so it makes good business sense to use discretion when deciding who should or should not be compelled to pay a missed appointment charge.

1 This sample is comprised of health care providers serving patients in more than one thousand different municipalities and cities throughout more than 30 states.

Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances

Comments

  1. By Cheryl Ebbing

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