Fee Policies for Missed Appointments

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Providers may charge for missed appointments, but

Policies for missed-appointment fees must be clear and conspicuously posted, and are best acknowledged in writing by practice patients. However, when charging a Medicare patient for a missed appointment, special consideration must be given to ensure that such a policy is designed to apply equally to all patients, both Medicare and non-Medicare, and does not discriminate against Medicare beneficiaries. CMS’s policy permitting such charges is articulated in Medicare Claims Processing Manual section 30.3.13, “Charges for Missed Appointments.” That Medicare permits a nondiscriminatory missed-appointment fee, however, does not necessarily mean that providers are free to charge one.

Since a charge for a missed appointment is not a “covered service,” Medicare’s assignment and limiting rules do not apply. As the Medicare Claims Processing Manual explains,

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.

CMS Pub. 100-04, Medicare Claims Processing Manual, Ch. 1, § 30.3.13 [PDF]. Before providers may charge, then, they must ensure that they can charge all patients, both Medicare and private insurance patients, equally.

Making this determination requires a close review of all of a provider’s third-party payor contracts, not all of which permit missed-appointment fees In fact, some contracts specifically prohibit charging patients directly, even for services that would otherwise be considered “noncovered.” Similarly, these obligations may not be clearly spelled out in a payor contract; they may be listed separately as part of a manual or collection of billing policies.

CMS has made its position on missed-appointment charges clear, but implementation of a missed-appointment fee in practice may depend entirely on the not-so-clear policies of other third-party payors. Providers intending to charge a missed-appointment fee should review their third-party payor contracts carefully or, even better, contact their payors directly and obtain confirmation that assessing this fee will not violate any aspect their provider agreement.

Bottom line: You can charge a reasonable missed-appointment fee if you can and do charge the fee to all your patients.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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