Can Doctors Bill Patients for Missed Appointments?
A New Answer to an Old Question

By: Ronald E. Nyman, Esq.

In the April/May 2004 issue of News Capsule, published by the Fairfield County Medical Association, I attempted to answer a question that doctors frequently ask: Is a physician permitted to bill for a missed appointment?

At that time, I answered that the federal government’s representative, the Centers for Medicare and Medicaid Services (CMS), had issued no concrete directive as to whether a practice could bill a Medicare patient for a missed appointment. The situation remained unresolved until October 2007, when CMS finally answered the question.

In Section 30.3.13 of the Medicare Claims Processing Manual, CMS allows physicians to charge Medicare patients for missed appointments, "provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments." CMS views the missed appointment fee not as a charge for a service itself, "but rather a charge for a missed business opportunity." As long as a missed appointment policy applies to all patients alike, the fee can be billed to Medicare patients. Physicians should note, however, that this fee should not be billed to Medicare, but directly to the patient.

With regard to commercial carriers, I believe my 2004 analysis remains valid. If a doctor contracts and, therefore, participates with a particular carrier, the doctor needs to review the carrier agreement to see if charging for missed appointments is prohibited. If there is no specific prohibition against such billing, I would recommend contacting a provider representative at the carrier. Many carriers have attempted to argue that a doctor cannot bill for a missed appointment even if the carrier agreement does not prohibit it. Although the carriers’ arguments appear specious, in many instances they are threatening doctors with removal from their network.

Now for the question that remains unanswered: If a commercial carrier prohibits a participating provider from charging a missed appointment fee, can the physician still charge Medicare patients for missed appointments? Remember, CMS requires that the physician treat all patients alike; however, what if a doctor cannot do this because it violates an agreement with a private carrier? CMS provides no answer to this dilemma, and physicians should be aware of this ambiguity in the regulations when instituting a missed appointment fee policy.

As I stated in my previous article, I would strongly recommend that a practice notify all of its patients of a "missed appointment" billing policy. This notification could include posting signs in the waiting room, mailing notices to patients, and having patients sign a document stating that they are aware of the policy. At the very least, patients will not be able to complain that the new policy was sprung on them without notice.

This article first appeared in the March 2008 issue of News Capsule, a publication of The Fairfield County Medical Association.