Author Topic: Billing Missed Appointment  (Read 4192 times)

camedbill

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Billing Missed Appointment
« on: September 25, 2011, 11:09:20 AM »
One of Dr. bills for missed appointment and eventhough this only gets billed to patient, he is applying an insurance adjustment before billing patient.  He claims that his contract with Blue Cross requires him to apply ppo adjustment on all charges to patient.
Does anybody know if this is true?  I thought missed appointment charges are just separate charges agreed to be paid by patients which has nothing to do with insurance

Michele

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Re: Billing Missed Appointment
« Reply #1 on: September 26, 2011, 07:59:02 AM »
Usually an office will have a policy for missed appointments that includes a set fee.  It isn't usually based on the allowed amount by an insurance carrier.  Policies on missed appointments must be clearly posted.  Some providers use their average office visit charge for the missed appointment but it isn't based on insurance.  BCBS doesn't allow providers to bill for missed appointments (insurance) so I'm not sure why they are going by their contracted rate.
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Buglet10

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Re: Billing Missed Appointment
« Reply #2 on: September 27, 2011, 10:07:22 AM »
HI,
In our office we charge a set fee of $50 for missed appts.  No insurance company has a contract regarding missed appt amounts to be charged.  Be careful because some EAPs and insurance like Mass Health which includes the Mass Health portion of Neighborhood Health Plan or Fallon does not allow you to charge for missed appts.  so check that you can charge the client.

PMRNC

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Re: Billing Missed Appointment
« Reply #3 on: September 28, 2011, 11:31:42 AM »
Quote
HI,
In our office we charge a set fee of $50 for missed appts.  No insurance company has a contract regarding missed appt amounts to be charged.  Be careful because some EAPs and insurance like Mass Health which includes the Mass Health portion of Neighborhood Health Plan or Fallon does not allow you to charge for missed appts.  so check that you can charge the client.

That's only true if using standard credentialing. However a negotiated contract with carriers CAN EXCLUDE the allowance of allowing patient's to be billed missed appointments. Some will compromise this verbiage by adding they don't want them charged more than the allowable amount. It's more of a "exclusion" of verbiage in the contract and I have negotiated these things out of contracts.
Linda Walker
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NuBiker

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Re: Billing Missed Appointment
« Reply #4 on: October 14, 2011, 06:41:02 PM »
We bill for the amount we are out due to the missed appointment.
So if the patient's copay is $20, and insurance pays $74, then the patient owes $94.
However, we offer to waive the penalty if the patient can make up the appointment within 10 days after they missed.
Makes for some very long work days, but it is a good compromise.

PMRNC

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Re: Billing Missed Appointment
« Reply #5 on: October 25, 2011, 08:14:55 AM »
Quote
We bill for the amount we are out due to the missed appointment.
So if the patient's copay is $20, and insurance pays $74, then the patient owes $94.
However, we offer to waive the penalty if the patient can make up the appointment within 10 days after they missed.
Makes for some very long work days, but it is a good compromise.

You still NEED to look at every contract because there are contracts that will prohibit you from billing a missed appt PERIOD. Violating this can result in a carrier removing you from their panel. Also many states strictly prohibit this with Medicaid patients as well.   When I do credentialing and am in the contract phase, this is one of the things on my check list I try to negotiate OUT of the contract before it goes to the attorney for approval.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com