Primary Care Coding Alert

Question: Are there any specific guidelines for billing no-show appointments for Medicaid patients?

New York Subscriber

Answer: Medicaid regulations are determined by state, so look first to your state’s rules.

For example, in a 2009 issue of the New York State Medicaid Update newsletter, readers can find explicit guidance that New York State does not reimburse providers for administrative fees. Specifically, the newsletter states: “New York Medicaid does not reimburse provider administrative fees for the following services provided to Medicaid enrollees … the federal >Centers for Medicare and Medicaid Services (CMS) have prohibited state Medicaid programs from allowing providers to bill Medicaid enrollees for missed appointments.”

However, you can still craft a no-show policy that otherwise applies to everyone not excluded by state or federal rules and post it in your waiting room along with any consequences of missing an appointment, such as penalty fees. You just can’t apply such a policy to Medicaid patients.

If you’re having a lot of no-shows with Medicaid patients, you can also look at some larger demographic issues. For example, Medicaid patients may rely on public transport, and that might be easier to access at certain times of the day. Or they may have jobs where they cannot control or don’t know their schedules when making an appointment — and can’t miss work without risking losing their jobs completely. Being aware of these issues can help your schedulers try to accommodate patients better, and possibly reduce no-shows.

Rachel Dorrell, MA, MS, CPC, CPPM, Development Editor, AAPC