Can You Charge a No‑Show Fee to Medicare Patients? What PTs Need to Know

No-show fee policies for Medicare patients often create confusion among physical therapy clinic managers. Your schedule gets disrupted from missed appointments. These absences reduce your practice's revenue and prevent you from helping other patients who need care.

Many clinic owners ask if charging Medicare patients no-show fees violates any regulations. The Centers for Medicare & Medicaid Services (CMS) provides clear guidelines about this situation. The Medicare Claims Processing Manual states you can charge Medicare beneficiaries for missed appointments under specific conditions that apply equally to all patients.

Understanding Medicare’s Policy on No-Show Fees

Medicare handles missed appointment fees in a way that is substantially different from its regular service billing policies. Standard medical services use complex Medicare fee schedules, but no-show fees belong to a completely separate category.

The Centers for Medicare & Medicaid Services (CMS) acknowledges that providers face real costs when patients miss appointments. Medicare allows clinics to charge patients for no-shows as long as they stick to specific guidelines.

This policy stands out because these charges represent an agreement between the provider and patient - not a charge to Medicare itself. This difference is significant for PT clinic owners. Patients bear personal financial responsibility for no-show fees, which cannot go through Medicare's claims process.

These missed appointment fees also operate outside Medicare's limiting charge regulations. Your clinic has more flexibility to set appropriate rates compared to standard Medicare services that follow fixed fee schedules.

Your clinic needs proper documentation that shows:

• Patient notification about your no-show policy in writing before any charges

• The same policy applies to all patients whatever their insurance type

• Detailed records of missed appointments and their charges

Note that Medicare might allow these charges, but state Medicaid programs often have their own rules. Check your state's Medicaid regulations, especially when you work with dual-eligible patients.

Conditions You Must Meet to Charge No‑Show Fee to Medicare Patients

Your PT clinic must follow specific compliance requirements to legally charge Medicare patients a no-show fee. The life-blood of Medicare's policy is non-discrimination—your missed appointment policy must apply to all patients, whatever insurance type they have. The fee amount must be similar for both Medicare and non-Medicare patients.

A no-show fee represents a charge for a missed business chance rather than a medical service. Medicare won't cover these missed appointment charges, so you must never submit them for payment.

You'll need a written policy that patients acknowledge to enforce these rules. This documentation protects you when questions about your billing practices come up.

Per Medicare Claims Processing Manual

- General Billing Requirements - 30.3.13 - Charges for Missed Appointments

CMS's policy is to allow physicians and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments. The charge for a missed appointment is not a charge for a service itself (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity. Therefore, if a physician's or supplier's missed appointment policy applies equally to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the physician or supplier from charging the Medicare patient directly.

Conclusion

Smart clinic owners see no-show policies as more than just ways to protect revenue. These policies help promote patient accountability. Before you set up any no-show fee structure, talk to a healthcare attorney who knows Medicare regulations. This will give a policy that meets federal requirements and shields your practice from missed appointments' financial effects.

Note that Medicare lets you charge no-show fees, but your policy should be fair and clear to keep your patients' trust. A properly designed, compliant no-show policy helps everyone—it protects your practice's finances while respecting your patients' Medicare rights.