Optometry Coding & Billing Alert

Question: Can our practice bill for no-show appointments? What are our legal rights as far as private payers are concerned?


Florida Subscriber

Answer: Whether you can bill for a no-show all depends on the payer. Generally for a governmental payer, such as Medicare, the answer is no. However, some third-party payers will allow you to bill for no-show appointments if you follow a certain outlined procedure. Be sure to read the details of your contract first.

For payers that do allow billing for no-show appointments, the contract will usually require you to give the patient advance notice of your no-show billing policy. And there may be a time limit dictating when patients must cancel by to avoid your billing them. For example, if a patient cancels more than 24 hours in advance, you cannot bill for the no-show.

If a payer contract allows you to bill for no-shows, that doesn't necessarily mean the carrier will pay the bill. The terms may indicate that you are allowed to bill the patient directly for a no-show appointment under certain circumstances. The payer might consider the no-show appointment as a non-covered service in this case.

And, for self-pay patients and those with indemnity insurance, billing for no-shows may be perfectly legal. However, you should check first to make sure your state law permits this type of billing.

The last thing to consider is collections success. Although your physician's time is valuable and doesn't deserve to be wasted by a thoughtless no-show patient, it may not be worth your staff time trying to collect payment for no-shows.