Medicare Policy on Missed Visit Fees
+ How You Can Help Your Front Office Staff PREVENT Cancels and No-Shows
If you have patients cancelling with late notice or patients who are no-showing for appointments, you know how it can negatively impact your schedule.
As I’ve shared before, every empty spot on your schedule represents a patient who isn’t getting the care they need and deserve. (watch that video here)
Medicare states that you can charge a missed visit fee for no-shows or late notice cancellations…but…there are some specific guidelines you need to follow:
According to Chapter 1, section 30.3.13 of the Medicare Claims Processing Manual, which is attached to CR5613, CMS policy allows physicians, providers, and suppliers to charge Medicare beneficiaries for missed appointments, provided:
that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments,
the late notice fees / charges for Medicare and non-Medicare patients are the same.
The 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.
Therefore, if a physician's or supplier's missed appointment policy applies equally to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the physician or supplier from charging the Medicare patient directly.
So, how do you apply this to your practice?
You will need a clear process that your team can follow.
Since Medicare states that you cannot discriminate, your team needs to handle all patients the same. They can’t charge some, but not others.
They need to know exactly how to handle patients, so they follow your policy.
Without a clear process, they’ll create their own and that’s where inconsistency begins. Start to finish, you need your patients to follow your expectations because every empty spot is a patient who isn’t getting care. And every same-day cancel, or no-show causes your front office staff to do extra work…
The goal shouldn’t be to charge a fee; it should be to prevent cancels and no-shows altogether. Why?
No one likes charging CX/NS fees and no one likes paying them. This is why it’s inconsistently handled and why patients either ‘get away with it over and over’ or they drop out when the staff try to charge the fee.
But here’s another thing to consider, inconsistently charging fees goes against the Medicare policy above. And it could be considered to be a form of discrimination if you charge one patient a fee and not another.
That doesn’t mean you shouldn’t charge a fee, but cancellation prevention should be the primary goal.
In 2013, my front office team got so tired of trying to deal with this problem that they begged me to find a solution.
I couldn’t find one, so I created my own. I developed an exact process that included steps to follow and specific scripts to use that got patients to agree to our expectations.
The team thrived because they had the right tools to manage patients and prevent cancels and no-shows.
Within 6 months the practice went from 75% patient arrivals to 95% patient arrivals day after day. Since 2013, their daily arrival rate has consistently remained at or above 95%.
Other practice owners started asking what the team was doing to achieve a 95% arrival rate. So, in 2016, I started Front Office GURU, to help other practices achieve similar results to our practice.
While that’s why I started my company, my mission became helping front office staff to win at their jobs. And I take joy in seeing them take control and be able to help more patients schedule and arrive for their care.
When they’re winning, you’re winning.
Are you struggling with cancels and no-shows? Does your team have difficulty discussing the cost of care and handling patients’ financial worries? Is schedule control an issue or are patient dropouts high? If so, I can help! And you’re reading this at the best possible time!
You can now provide your front office team with consistent training, a proven system, and help them know what to say and when to say it.
With The Front Office GURU Training Academy, you can access your own private platform with more than 100 video lessons, scripts, audio demonstrations, and so much more!!
Learn more about my virtual training platform and give your team the tools they need to prevent cancels and no-shows, and ensure patients schedule and arrive for care.