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.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.
The Centers for Medicare & Medicaid Services finalized several changes in Medicare Advantage and Part D on Friday.
The Trump administration has finalized several changes in Medicare Advantage (MA) and Part D in anticipation of bid submissions on June 1.
The Centers for Medicare & Medicaid Services (CMS) released Friday that includes ...
As practices begin reopening across the nation, there are several things that need to be considered. Policies and Procedures Manuals need to be updated, malpractice carriers need to be contacted and everyone needs to consider mental health screenings and support.
If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.
The use of Modifier 25 is one example ...
To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number.
Take a look at the following
J1071 - Injection, testosterone cypionate, 1mg
For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL
(100 mg/mL = 1 mL and there are ...
As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.