Physicians should note, however, that this fee should not be billed to Medicare, but directly to the patient.

With regard to commercial carriers, I believe my 2004 analysis remains valid. If a doctor contracts and, therefore, participates with a particular carrier, the doctor needs to review the carrier agreement to see if charging for missed

appointments is prohibited. Ifthere is no specific prohibition against such billing, I would recommend contacting a provider representative at the carrier. Many carriers have attempted to arguethat a doctor cannot bill for a missed appointment even if the carrier agreement does not prohibit it. Although the carriers' arguments appear specious, in many instances they are

threatening doctors with removal from their network.

Now for the question that remains unanswered:If a commercial carrier prohibits a participating provider from charging a missed appointment fee, can the physician still charge Medicare patients for missed appointments?

In the April/May 2004 issue of News Capsule, published by the Fairfield County Medical Association, I attempted to answer a question that doctors frequently ask: Is a physician permitted to bill for a missed appointment?

At that time, I answered that the federal government's representative, the Centers for Medicare and Medicaid Services (CMS), had issued no concrete directive as to whether a practice could bill a Medicare patient for a missed appointment. The situation remained unresolved until October 2007, when CMS finally answered the question.

In Section 30.3.13 of the Medicare Claims Processing Manual, CMS allows physicians to charge Medicare patients for missed appointments, "provided that they do not discriminateagainst Medicare beneficiaries but also chargenon-Medicare patients for missed appointments."CMS views the missed appointment fee not as a charge for a service itself, "but rather a charge for a missed business opportunity." As long as a missed appointment policy applies to all patients alike, the fee can be billed to Medicare patients.

Many carriers have

attempted to argue that a

doctor cannot bill for a

missed appointment even

if the carrier agreement

does not prohibit it.

Can Doctors Bill Patients for Missed Appointments?A New Answer to an Old Questionby Ronald E. Nyman, Esq.

MediStar12 Cambridge DriveTrumbull, CT 06611Toll-free: (888-423-8080)Phone: (203) 372-1900Fax: (203) 372-2600www.medistarbilling.com

©2007 Medi-Claim Services, Inc. All rights reserved.

MediStar, the MediStar logo, Credentials Xpress, Meducation, and Meducational are service marks of Medi-Claim Services, Inc. Other trademarks are property of their respective owners.

Whichever course the practice ultimately takes, I would strongly recommend that a practice notify all of its patients of a missed appointment billing policy. This notification could include officesignage in the waiting room, mailing notices to patients and having patients sign a document stating that they are aware of the policy. At the very least, patients will not be able to complain that the new policy was sprung on them without notice.

Ronald E. Nyman, Esq. is founder and presidentof Medi-Claim Services, Inc.

One additional complication arises when a patient misses an appointment for what would have been a covered service. For example, if a patient made an appointment for a preventative exam and the carrier would have paid the doctor $75.00 for the exam, can the doctor bill the patient for a missed appointment where the bill would be greater than the $75.00 reimbursement?

If the doctor does not participate with a carrier,then the analysis becomes somewhat easier. If there is no agreement between doctor and carrier,then the doctor should be able to bill the patient for the missed appointment.