by Wyn Staheli, Director of Research
February 7th, 2019
Some providers mistakenly think that they cannot bill a missed appointment fee for Medicare beneficiaries. You can, but Medicare has specific rules that must be followed. These rules are outlined in the Medicare Claims Policy Manual, Chapter 1, Section 30.3.13. You must have an official “Missed Appointment Policy” which is the same for ALL your patients. In other words, they don’t want you penalizing Medicare patients differently than other patients.
There are no fee amount guidelines other than the fact that you cannot charge a Medicare patient any more than you would charge a non-Medicare patient. This goes back to the one policy for all patients described above.
These charges should not be submitted to Medicare because they are the responsibility of the patient. It would be a good idea to include your “Missed Appointment Policy” as part of your “Informed Financial Consent Policy” so the patient fully understands their financial responsibility. See “Step 2. Establish Patient Financial Responsibility” in Chapter 1.1 of the ChiroCode DeskBook or one of Find-A-Code's Reimbursement Guides for more information.
One last thing to note is that there is no ABN required for a missed appointment charge.