tci General Surgery Coding Alert - 2008 Issue 6

Reader Questions: CMS Says No-Show Fee Is OK -- Sometimes

Question: What is Medicare's billing policy for missed appointments? Wisconsin Subscriber Answer: MLN Matters article 5613 (http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf) states that you may charge for missed appointments for Medicare patients, with a few caveats. Caveat 1: Your no-show charge policy needs to apply equally to your Medicare and non-Medicare patients. You must consistently charge all patients the same amount for missed appointments. Caveat 2: You should not bill Medicare for the missed appointment. Instead, you-ll bill the patient directly. Medicare will deny missed-appointment claims, citing reason code 204 (This service/equipment/drug is not covered under the patient's current...

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