Although it’s common to charge patients a no-show fee to deter missed appointments, there is more to it than just modifying your office policies. No-Show Fees.
If implemented incorrectly, charging a no-show fee can increase your risk of violating payer contracting rules, and result in higher losses than the original missed appointments.
It’s vital that your practice clearly understands what, when and to whom you can and can’t charge a patient for missing an appointment.
Who Pays for Missed Appointments? No-Show Fees
There is no CPT code for missed appointments. Accordingly, payers will never compensate you for a no-show fee.
Although Medicare and private payers won’t reimburse you for patient missed appointments, they typically don’t prevent you from charging for them either. However, if your payer does have guidelines related to charging no-show fees it will be in their contract.
Note: If your payer contract prohibits you from charging for no-shows, this may also apply to late cancellations. You should confirm this with each of your payers before implementing your No-Show Policy.
No-Show Fee Rules
Individual payer contracts can have different requirements related to no-show fees, and your practice policy must comply with each one. Accordingly, taking the time to carefully read each payer contract is vital.
As you know, many commercial payers follow Medicare guidelines. Therefore, complying with Medicare rules is a good place to start.
Currently, Medicare allows you to charge its beneficiaries a fee if they miss an appointment. However, their guidelines make it clear that you must not discriminate against their members. To comply with Medicare guidelines related to charging no-show fees, all of your patients must be governed by the same rules (regardless of their payer).
Resource: You can find Medicare’s rules regarding missed appointments in the CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 1, Section 30.3.13.
Setting Your No-Show Fee
Although Medicare guidelines allow you to charge a no-show fee for missed appointments, they don’t indicate how much it should be. However, they do require that you charge Medicare and non-Medicare patients the same amount.
So, how much you charge is really up to you, but there are a couple of things you should consider before setting your rate:
1. Reason for the Fee: Remember that you are not charging for the money you lost related to the missed appointment (so you shouldn’t charge the same as an office visit). Instead, you are charging a fee to discourage your patients from late canceling or missing their appointments.
2. Patient Populations: Excessive no-show fees can be prohibitive for some patient populations. Setting your rate too high can be a financial burden to some patients and result in them leaving your practice. This is certainly not the outcome you want.
Note: Remember that regardless of the policy you are implementing, you must treat all patient populations equally. Not only does this comply with Medicare guidelines, but it can also you help avoid possible claims of discrimination.
Providing Payment Options
Your practice and patients are unique. That means the options you include in your No-Show Policy will most likely be different from those offered by another practice. You have to find what works for you. Here are several options to consider when crafting your No-Show Policy:
1. Flat Rate: One no-show fee for each appointment missed starting with the first one. This option is quite strict and possibly not the best one to go with unless you’ve tried everything else.
2. Rate Ramp Up: Implement lower initial fees that increase if the patient continues to miss appointments or late cancel.
3. Number of Appointments: Give patients a freebie with a warning. The first time a patient misses an appointment, inform them that you’ll waive the no-show fee outlined in your policy. However, if they miss an appointment again without canceling within your set parameters, they will be required to pay $XXX.
4. Credit Card on File: Get a credit card from patients to keep on file that you will charge should they miss an appointment without the amount of required notice. It can be helpful to have patients initial your No-Show Policy next to this portion of the document to highlight its important, and to ensure there are no misunderstandings or surprises. For more information on how to include this option in your No-Show Policy, check out this post, Credit Card No-Show Policy: Is It the Right Action to Take?
There is additional help available to help you reduce your risk and better manage your no-show patients from healthcare compliance attorney Gina L. Campanella, Esq., FACHE. During her online training, Gina will provide you with step-by-step answers and plain-English strategies to help you implement a no-show policy that is compliant and that brings down your no-show percentage. This training is immediately accessible once you register.
Note: For your No-Show Policy to be successful, you must also have a straightforward patient notification process in place. Without one, you can pretty much guarantee that your new policy will result in very dissatisfied patients. For more information on implementing a successful No-Show Policy, check out Healthcare Training Leader’s Blog on October 8th for a follow-up to this post.
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