Optometry Coding & Billing Alert

Question: I-ve heard that Medicare changed its policy on billing for missed appointments. What does the policy say, and does it mean that we can't charge for missed visits anymore?

Wisconsin Subscriber

Answer: CMS did issue a Medlearn Matters article about its policy for charging for missed appointments (MLN Matters article 5613, which you can find at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf).

Good news: You now have a very clear answer on whether you can charge Medicare patients if they miss an appointment. That answer is yes, with a few caveats.

Caveat 1: Your no-show charge policy needs to apply to both your Medicare and non-Medicare patients. You cannot discriminate against Medicare patients by only charging them and not your other patients who miss appointments. You also have to charge the same amount to all of your patients.

Caveat 2: You should not bill Medicare for the missed appointment. Instead, you-ll bill the patient directly. If you do bill a missed appointment to Medicare, your claim will be denied citing reason code 204 (This service/equipment/drug is not covered under the patient's current benefit plan).

Note: The implementation date for this CMS policy is Oct. 1.