The COVID-19 pandemic has definitely resulted in everyone sailing into waters that may be unfamiliar. As we at Systemedic track and evaluate data, this allows us to identify trends as we review bills we receive from providers. A recent trend we have noticed is an increase in significant charges for missed appointments. Listed below are some guidelines we suggest in order to avoid these charges:
- To avoid charges to workers’ compensation payers related to missed appointments, the injured workers should cancel any appointments they may not be able to attend. A minimum of twenty-four hours’ notice of cancellation is recommended.
- If your company or covered employers choose to use a provider that bills for missed appointments, you may want to negotiate with the provider and try to reach an agreement ahead of time to bill at a lower rate, since the worker will not be examined by clinic staff.
We have identified a few clinics that are frequently billing the same amount for missed appointments as for the 4th highest out of 5 levels of Evaluation and Management services described in CPT by history, examination, complexity and severity, even though no examination was performed.
Generally, it is not possible for us to verify the requirements in Rule 30 (below), that the appointment was arranged by the carrier or the employer and when the provider is unable to arrange for a substitute appointment for that time.
Rule 30, I.M. Missed Appointment
A provider shall not receive payment for a missed appointment unless the appointment was arranged by the carrier or the employer. If the carrier or employer fails to cancel the appointment not less than twenty-four hours prior to the time of the appointment and the provider is unable to arrange for a substitute appointment for that time, the provider may bill the carrier for the missed appointment using procedure code 99199 with a maximum fee of bill review.
We know workers’ compensation can be confusing at times and that is why you choose the experts in Arkansas workers’ compensation. We bring clarity to workers’ compensation.