Saturday, July 7, 2007

Can Providers bill for Missed or No Show Visits?

A client wrote me last week the following scenario:
8:00 am and all is quiet. A quick glance at the schedule let's me know that I am going to have a busy day so I need to enjoy this brief moment before things pick up. I have over 20 patients scheduled and 1 doctor to treat them all.

The middle of the day and things are going well. I look at the schedule and we have treated 10 patients so far. 1/2 done YEAH our next patient is a sweet elderly woman who started getting treated a few months ago. She is usually a few minutes early but today it appears she is really behind putting me behind schedule. I call the patient and identify that she hasn't even left her home but completely forgot about her appointment .

We rescheduled her appointment but now I am in a dilemma. Can I bill her for this visit as a No Show? She is a Medicare patient but can we bill Medicare patients for No Shows? We charge $35.00 for our other patients who do not cancel within 24 hours.

The answer is YES
Medicare has stated that a provider can bill Medicare patients for missed appointments not as a service but as a missed business opportunity. The provider is responsible for billing all of their patients the same and can not discriminate against Medicare beneficiaries.

If the provider accidentally bills Medicare for a missed visit charge Medicare will process the claim and submit a EOB with Reason Code 204: This service or equipment/drug is covered under the patient's current benefit plan.

To read Medicare's complete statement:

To read more about Medicare updates including Billing Health Insurance Information check out Medicare Medical Coding and Billing Courses

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