Practice Management Alert

Question: My office has had an uptick in no-show patients. One of my coders says that he can bill the payer anyway, so we as a practice don’t take the hit financially. Is this true?

Rhode Island Subscriber

Answer: No. If the office has determined it will pursue a billing program for no-shows and the policy clearly states the terms, you must know who to bill. For situations like these, do not bill the payer; the practice may only bill the patient.

Payers may only be charged for rendered medical services and/or supplies utilized on the patient. “No-show” appointments mean that no patient showed up and no medical services were performed — therefore the payer cannot be billed.

“During my time as a practice manager, we never billed for situations like this,” said Judy Klobutcher, BSN, MBA, CPC, coding specialist at nThrive in Ashland, Ohio.

Some coders believe you can use CPT^® code 99199 (Unlisted special service, procedure or report) to bill payers for no-shows, but this is not true. The code descriptor’s vagueness has allowed this myth to be perpetuated over the years; offices that have used it often set up an internal charge code with a description of the charge that generates on the patient’s bill.

No one likes to lose patients. However, patients who consistently miss appointments can result in practice financial liability. If the problem reaches a significant percentage of your patient base, it may be in the practice’s best interest to terminate the relationship. As long as the etiquette is clearly outlined in the policy, an office can decide to refuse a patient after a certain number of no-shows.

For instance, “we sent letters and after three no-shows, we dismissed” the patient “from our practice. If they were never seen by our practice, we didn’t make any more appointments and notified the referring provider— if there was one),” Klobutcher said.