Billing for Missed Appointments/No-Shows
Providers and Suppliers frequently ask, "Can I bill for missed appointments/no-shows?"
Medicare Guidelines prohibit providers and suppliers from billing Medicare Carriers for missed appointments/no shows. Billing Medicare for missed appointments/no-shows can be considered a form of fraudulent billing.
The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-1, Medicare General Information, Eligibility, and Entitlement
Chapter 1 - General Overview, Section 20.3.1, Definition and Examples of Fraud, provides several examples of fraudulent billing. Medicare fraud may take the form of providers or suppliers who bill Medicare for appointments the patient fails to keep. The following statement appears in the IOM manual mentioned above as a possible form of fraud:
"Billing for services that were not furnished and/or supplies not provided. This includes billing Medicare for appointments that the patient failed to keep."
To view a copy of this publication, please refer to the following CMS Website location:
http://www.cms.hhs.gov/manuals/downloads/ge101c01.pdf (pdf - 20 pages; 121KB)
It is important to note that although a provider or supplier may not bill the Medicare program for "missed appointments/no shows" (because no covered service was rendered), the beneficiary may be billed. Such billing charges do not relate to any service covered under the Medicare statute, so neither CMS nor WPS may interfere with the provider's billing policy for "missed appointments/no shows." However, to avoid possible discrimination or civil right violations, the provider should be certain that this billing policy is applied equally to both Medicare and non-Medicare patients.
In addition, there is an exception to the above stated guideline. CMS Publication 100-4, Medicare Claims Processing Manual, Chapter 8, Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims, Section 10.3, No-Shows, states the following:
"If a facility sets up in preparation for a dialysis treatment, but the treatment is never started, e.g., the patient never arrives, no payment is made. In this case, no service has been furnished to a Medicare beneficiary even though staff time and supplies may have been used. Furthermore, the facility may not bill the patient or the patient's private insurance for these services. This is because the program is already paying the cost of pre-dialysis services through the facility's per treatment composite rate. In setting that rate, CMS has included the salaries of facility personnel and the cost of supplies used for furnishing pre-dialysis services."
"Therefore, these costs (e.g., salaries for staff time, overhead, supply costs) are included in the facility's costs and reported on its cost report, and they are included in the allowable costs used to set future reimbursement rates under the composite rate system for ESRD facilities. However, these costs may not be used as the basis for a facility to request a reimbursement exception to its composite rate, nor may they be reimbursed as Medicare bad debts."
To view a copy of this publication, please refer to the following CMS Website location:
http://www.cms.hhs.gov/manuals/downloads/clm104c09.pdf
(pdf - 95 pages; 542KB)
