Ensure Your Practice Does Not Lose Money Due to 'No-Shows'

Every practice has the occasional patient who doesn't turn up for an appointment; however if no-shows are becoming common in your practice, it's time to get tough. Here are some expert-details from our experts on ways to ensure your practice does not lose money because of innumerable missed services.

Focus on the patient's insurance

Probably the best way to encourage patients to keep their appointments or call you if they need to cancel is to charge a fee when they don't turn up. However, when, and if, you can charge a no-show fee depends on the insurance your patient has.

In most instances, you should be able to charge patients a fee when they miss an appointment. However check your contracts as you may have a clause forbidding no-show charges or specifying particular cases when you can and cannot bill the patient. For instance, most payers won't allow you to charge a patient who cancelled her appointment more than 24 hours prior to the scheduled appointment.

As of 2007, Medicare allows to bill for no show appointments. But then we still cannot bill Medicaid. You are allowed to bill a Medicare patient a no-show fee as long as you do not distinguish and charge your Medicare patients only. Apply the same no-show policy and fee to all of your patients.

For self-pay patients and those with indemnity insurance, billing for no-shows may be completely legal. But then, you should check first in order to ensure your state law allows this type of billing.

Just because your contract says you can bill for a no-show fee, do not be tempted to bill the payer. Most likely, you will need to bill the patient or you will get a non-covered service denial. For instance, if you bill a missed appointment to Medicare, your claim will be denied citing reason code 204. (This service/equipment/drug is not covered under the patient's present benefit plan).

Explain your policy

For payers that allow you to bill for no-show appointments, the contract will normally require you to give the patient advance notice of your no-show billing policy.

Good practice: Have a financial policy that mentions the fee in writing and include that policy in the paper work you give to every new patient. Have the patient sign two copies of the policy: one that he keeps in addition to one you will keep with his chart.

Include information such as the following in your policy:

The patient needs to inform you that he's not going to show

Whether you will charge a fee

What is the fee if you are going to charge a fee at all

The first time you see a patient, make it a point to sign a 'no show and cancellation form'. It tells them that if they don't show up or cancel within 24 hours of their appointment, they will be charged.

If your practice calls patients to remind them of their appointments, think about mentioning the no-show fee during those reminder calls as well. You can even post the information about your fees in the registration area and in the waiting room.

Fix your fee: Your no-show policy should tell exactly what fee you'll charge for a missed appointment. Many practices set one fee for an office visit and another, higher fee for procedures. The going rate around here is $50 charge for office visits and $100 if they had a procedure scheduled.

One way to bring down your no-show rate, particularly for procedures, is to collect a deposit when the patient schedules the appointment.

Think about discharge for repeat offenders

Medical Coding: Most practices allow patients one or two freebies, which means that they excuse the first missed appointment and don't charge a fee. However, you should send a letter to the patient, reminding him of your practice's policy on no shows.

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Once you have sent a letter reminding the patient of the policy, you should think about charging a fee for additional missed appointments. After that, if the patient starts to consistently schedule no-show, you have the right to discharge him as a patient after a few offenses.

People send reminder letters for the first two no-show appointments. The third one gets a $50 fee since that is to cover that appointment time. During the fourth no show, the patient is discharged from the practice.

Key: When a patient does miss an appointment without notifying the office beforehand, you should note it in the patient's file. This will provide you an accurate count of how many times a patient has been a no-show. Spot on documentation can help with any legal issues that crop up if you end up discharging a patient from your practice.