GoHealthcare Practice Solutions | Human Intelligence Meets AI Innovation
  • About
    • In the News
    • Privacy Policy
    • Terms of Use
  • Leadership
  • Contact Us
  • Testimonials
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • Readers Questions
  • Artificial Intelligence Division

Blog Posts

billing missed appointment for medicare

9/19/2017

0 Comments

 
​Can you bill a Medicare Patient for Missed Appointment or No-Show?
Picture
When patients missed their appointments, it does cost you your time and your staff. In this article, you are wondering if you can bill Medicare when their beneficiaries missed and appointment or has no-show. Below you will find clarifications.
​According to Chapter 1, 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 nonMedicare 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.
The other key points of CR5613 are:
  • The provider may bill the Medicare beneficiary directly. • Medicare does not make any payments for missed appointment fees/charges that are imposed by providers, physicians, or other suppliers.
  • Claims for missed appointments sent to Medicare will be denied with the reason code 204 (This service/equipment/drug is not covered under the patient’s current benefit plan.).
  • In most instances, a hospital outpatient department can charge a beneficiary a missed appointment charge.
  • In the event, however, that a hospital inpatient misses an appointment in the hospital outpatient department, it would violate 42 CFR 489.22 for the outpatient department to charge the beneficiary a missed appointment fee. 
According to Medicare guideline; "make certain that your billing staff is aware that you may bill the beneficiary directly, that Medicare itself does not make any payments for missed appointments, and that Medicare should not be billed for these charges".
"The Centers for Medicare & Medicaid Services (CMS) policy is to allow physicians and suppliers to charge Medicare beneficiaries for missed appointments. However, Medicare itself does not pay for missed appointments, so such charges should not be billed to Medicare."
"Providers may not charge ONLY Medicare beneficiaries for missed appointments; they must also charge non-Medicare patients. The amount the physician/supplier charges Medicare beneficiaries for missed appointments must be the same as the amount that they charge non-Medicare patients.​"

Source: 
MLN: MM5613 Related Change Request Number: 5613
Need our professional consulting advise to run a more efficient Revenue Cycle Management? - call and talk to us at 609-481-3494
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Picture
    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio, MSC, CSPPM, CRCR, CSBI, CSPR, CSAF is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

    Current HFMA Professional Expertise Credentials: 
    HFMA Certified Specialist in Physician Practice Management (CSPPM)
    HFMA Certified Specialist in Revenue Cycle Management (CRCR)
    HFMA Certified Specialist Payment & Reimbursement (CSPR)
    HFMA Certified Specialist in Business Intelligence (CSBI)

    View my Profile on Linkedin
    View my profile on LinkedIn
    READERS QUESTIONS

    search here


    RSS Feed

    Archives

    June 2025
    May 2025
    April 2025
    March 2025
    January 2025
    December 2024
    November 2024
    September 2024
    August 2024
    July 2024
    March 2024
    February 2024
    October 2023
    September 2023
    August 2023
    July 2023
    June 2023
    May 2023
    April 2023
    March 2023
    February 2023
    January 2023
    November 2022
    September 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    October 2021
    July 2021
    June 2021
    February 2021
    January 2021
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    April 2020
    March 2020
    December 2019
    February 2019
    September 2018
    August 2018
    February 2018
    January 2018
    December 2017
    September 2017
    August 2017
    June 2017
    May 2017
    February 2017
    October 2016


    Categories

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    2025 RCM Trends
    Chronic-care-management-in-2017-changes
    Events
    In The News
    Medical-modifiers
    Medical-modifiers
    ​Outsourcing Prior Authorization For Oncologic Surgery | Navigating Complexities For Improved Patient Care
    Pain Management Billing
    Pain-management-billing
    Pain Management Billing Codes
    Practice Management
    Readers Question
    Revenue Cycle
    Spinal-fusion-billing-and-coding
    Spinal-fusion-billing-and-coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder

    RSS Feed


    BROWSE HERE

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    2025 RCM Trends
    Chronic-care-management-in-2017-changes
    Events
    In The News
    Medical-modifiers
    Medical-modifiers
    ​Outsourcing Prior Authorization For Oncologic Surgery | Navigating Complexities For Improved Patient Care
    Pain Management Billing
    Pain-management-billing
    Pain Management Billing Codes
    Practice Management
    Readers Question
    Revenue Cycle
    Spinal-fusion-billing-and-coding
    Spinal-fusion-billing-and-coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder

    RSS Feed


© COPYRIGHT 2019 GoHealthcare Consulting and Business Development LLC. ALL RIGHTS RESERVED.
Photos from shixart1985 (CC BY 2.0), www.ilmicrofono.it, shixart1985
  • About
    • In the News
    • Privacy Policy
    • Terms of Use
  • Leadership
  • Contact Us
  • Testimonials
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • Readers Questions
  • Artificial Intelligence Division