Your time is valuable, and it is frustrating to have no-shows or last minute cancellations. The first order of business is to determine whether or not State law addresses the issue of charging patients for missed appointments. Many states prohibit this for Medicaid patients, but do not speak to other types of payors. State law might also address the factors that must be considered (and which should be documented in a file) when determining what a missed or cancelled appointment fee dollar amount should be.
State Medical boards have taken the position that physicians may charge patients a missed appointment or cancellation fee as long as there is a written policy in place, the patients receive adequate notice in advance, and the fee is reasonable. Similarly, the American Medical Association has taken the position that a physician may charge a patient for a missed appointment or for one cancelled 24 hours in advance if the patient is given adequate notice.
When implementing a missed appointment or cancellation fee policy, it is recommended that the physician:
- Provide patients with advance notice of the fee at the time the appointment is scheduled or reminds patients of the fee when leaving an appointment reminder voice message or sending an appointment reminder e-mail or text;
- Post a sign in the waiting area regarding the policy on missed/cancelled appointments (including how far in advance the patient must call to cancel before incurring a charge and how much the fee is);
- Include the missed appointment/cancellation policy with patient intake forms for the patient to sign, acknowledging notice of the policy;
- Does not charge new patients a missed/cancelled appointment fee, if they have never been in the office to acknowledge receipt of the policy (unless intake forms are generated and signed online or through email when booking occurs);
- Does not charge a missed/cancelled appointment fee that exceeds the amount that would have been paid for a regular visit;
- Charges the same fee to every patient that misses or cancels an appointment (except when missed/canceled appointment fees are prohibited by contract or regulation).
Notwithstanding the permissibility of missed/cancelled appointment fees, some insurers prohibit them in their contracts. Providers should be sure to review their payor contracts before implementing a missed/cancelled appointment policy on the members of such insurer.
The Federal government’s Medicare policy is to allow physicians to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries and also charge non-Medicare patients for missed appointments. The charge for a missed appointment is not considered a charge for a service itself, but rather is a charge for a missed business opportunity. Therefore, if a physician’s missed appointment policy applies equally (including the amount of the fee) to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the physician from charging the Medicare patient directly. It should be noted that Medicare does not make any payments for missed appointment fees/charges that are imposed by physicians. Accordingly, charges to Medicare beneficiaries for missed appointments should not be billed to/part of claims submitted to Medicare.
