September 2, 2022 | By Bryan Meek, Esq., Brennan, Manna, and Diamond
Patients missing their healthcare appointments without adequate notice can cost practices a lot of money, as well as deprive patients of necessary care. While one solution to mitigate this damage is to charge patients for missed appointments, policies should be written in such a way that they do not violate state or federal laws, including Medicare and Medicaid.
The Centers for Medicare and Medicaid Services (“CMS”) published an article providing guidance on practices charging Medicare beneficiaries for missed appointments. The key takeaway is that while Medicare does not prohibit charging for missed appointments, the charge must be sent directly to the beneficiary and not to Medicare. Additionally, practices should not discriminate against Medicare beneficiaries – if the practice is going to charge Medicare beneficiaries for missed appointments, non-Medicare patients should also be charged, and at the same rate. Additionally, CMS also requires that “[t]he charge for a missed appointment is not a charge for a service itself (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity.”
As for Medicaid, practices should avoid charging Medicaid beneficiaries for missed appointments in order to comply with both 42 U.S.C. § 1396a(a)(14) and 42 C.F.R. § 447.15.
If patients have private insurance, looking to the insurer’s specific policy or contract will be useful in determining whether missed appointment fees can be charged at all, and if they can be, whether the fee can be billed directly to the insurer or must be billed to the patient directly. Insurers might impose other restrictions as well – such as putting a cap on the amount that can be charged to a patient for a missed appointment.
When practices implement a “Missed Appointment Fee” policy, employees should be properly trained to charge patients equally, and certain employees should be designated to follow-up with patients after missing an appointment.
The language in the policy itself should be easy for patients to understand and should reiterate that the fee is not for the service itself, but rather the missed business opportunity. Additionally, there should be clear standards as to how far in advance a patient can cancel without incurring a charge, and if there are any exceptions to the charge (i.e., no charge for the first missed appointment). The actual charge should also be clearly written into the policy, which should take into account any potential caps.
Lastly, if the patient’s credit card will be kept on file, that should also be included in the policy, which will require the practice to comply with the Health Insurance Portability and Accountability Act, and the Payment Card Industry Data Security Standard.
While charging patients for missed appointments may seem like a simple solution to mitigating losses, there are a lot of different factors that come into play due to the variances in rules by different insurers. Therefore, practices should be sure to incorporate Medicare, Medicaid, and private insurance standards in their policies, where applicable, and staff should be properly trained on carrying out the policy in order to eliminate unequal charges or treatment among patients.
If you have any additional questions about charging patients for missed appointments, please contact Brennan, Manna & Diamond Healthcare Partner Bryan Meek at firstname.lastname@example.org. Bryan would also like to thank Rachel Stermer for her assistance and contribution to this article. Rachel is currently waiting on her Bar exam results to become an attorney.