# No show fees for Medi-Cal patients



## jhendrix08 (Dec 17, 2019)

Hi everyone...

Hoping someone can guide me in the right direction. Our office has recently implemented a no-show fee and we are in the process of having all of our patients sign an updated office policies, which includes this new fee. Someone in the office mentioned that we are not allowed to charge Medicare/Medi-Cal patients a no show fee, by law.  

Does anyone have info they can provide on this? We are in California.

Thanks so much for any help!


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## Britte (Jan 13, 2020)

Yes you can bill the patient! https://www.aapc.com/blog/23888-how-to-bill-for-missed-appointments/


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## csperoni (Jan 13, 2020)

You are permitted to charge your Medicare patients a no show fee.  For Medicaid however, most states (California included) do NOT permit you to charge patients a no show fee.  No show fees for commercial insurance are permitted.
Your policy should be official and in writing.  It is certainly advisable to have the patient sign a confirmation of such, but is typically not required.  
The policy must be the same for all patients, excluding those prohibited by law (Medicaid).


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## jhendrix08 (Jan 14, 2020)

csperoni said:


> You are permitted to charge your Medicare patients a no show fee.  For Medicaid however, most states (California included) do NOT permit you to charge patients a no show fee.  No show fees for commercial insurance are permitted.
> Your policy should be official and in writing.  It is certainly advisable to have the patient sign a confirmation of such, but is typically not required.
> The policy must be the same for all patients, excluding those prohibited by law (Medicaid).



Thanks so much for taking the time to answer my question, Christine! So the patient's that we specifically wondering about are those that have Medicare primary and Medi-Cal secondary....since Medicare is primary, can we still charge these patients a no-show fee? (We don't have any patients that are Medi-Cal primary).  Any chance you can direct me to some literature on this? I can't find a thing and I've tried calling Medi-Cal on two occasions and have sat on hold.

We do have the policy in writing in our updated office policies that we are having every patient read and sign at check-in. This document then gets scanned into their chart. 

Thanks again for your help. I've not had much luck with researching on my own so far.


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## csperoni (Jan 14, 2020)

I found several sites that say it's not permitted, but none provided an exact reference for California, other than finding the exact law for mental health providers (below). Several websites also stated billing Medicaid recipients for no-shows is prohibited by federal law, but there are definitely some states that permit it.  California Code of Regulations, Title 9, Sect 1810.365 specifies:
 The MHP of a beneficiary, or an affiliate, vendor, contractor, or sub-subcontractor of the MHP shall not submit a claim to, demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health services provided under this Chapter or related administrative services such as billing for missed appointments or making copies of client records, except to collect:
(1) Other health care coverage pursuant to Title 22, Section 51005.
(2) Share of cost as provided in Title 22, Sections 50657 through 50659.
(3) Copayments in accordance with Section 14134 of the Welfare and Institutions Code and Title 22, Section 51004.

For example, I know it's not permitted for Medicaid (which includes Medicaid managed care by the way) in NY either, but certainly couldn't quote the exact statute.  Where it is prohibited, you may not bill a patient who has Medicaid as either primary or secondary.  I do know there are offices that will discharge patients for repeated no-shows, which is another option. 
In my opinion, there are a few options to deal with no shows, and there is no one size fits all answer.  It will depend on the type of practice you have, and how much no-shows impact your operations.
If you are a subspecialty practice that books 45 minute appointments, even 2 no-shows in a day create a non-productive provider, and unnecessary long waits to schedule an appointment.  If you are a type of practice that double books, and has an appointment every 10 minutes, then a few no shows are simply an opportunity for your provider and staff to actually eat a slice of pizza.  Historically, the best way to reduce no shows is with reminder calls or texts.  Supposedly the service companies that offer texting reminders seem to indicate it's a much better method than robo-call reminders.    
My personal opinion would be to let the 1st missed appointment slide for all practices, with a warning that a repeat missed appointment will result in a fee.  If you have a habitual "no show"er, then you could consider discharge from the practice - again, with a warning first and following all rules/regulations for discharging a patient.


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## jhendrix08 (Jan 14, 2020)

You're the best; truly. I can't thank you enough for your time spent helping me with this. 

Yes, I completely agree with your opinion on this issue. We do have a system in place for reminder calls/texts/emails and unfortunately, still get quite a few no-shows now and then. Our previous way to handle this was 3 no shows and we discharge the patient from our practice (this did include a "warning" letter, after the 1st now show) This did help but our physician has decided he wants to try to implement a no show fee now to see if that helps bring the number down further, so we're going to give it a try. 

I'm going to discuss this with him and let him know we need to not charge the Medi-Cal patients for missed appointments. For this patient population, we can just continue to follow our policy of 3 missed appts results in discharge from the practice. 

Thanks again for your time. You've been so helpful!!


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