As is standard procedure in medical billing practices, patients who do not cancel an appointment with at least 24 hours’ notice or do not attend the visit are considered no shows. Estimated no-show rates are 5-7%. While this may seem low, it decreases revenue, costs, you and your staff time and can affect patient results. 

Following are some tips that may provide some guidance on billing management for patient no-shows:

  • Always review patient contracts before billing no-show charges. For instance, Medicare patients can be billed directly, but providers will not receive payment from Medicare. In addition, all patients (regardless of insurance coverage) are charged the same, prohibiting Medicare patients from discrimination. 
  • Post your no-show fee policy on your website, in your office, and on patient paperwork such as appointment reminders. Also, ensure that staff verbally communicate to patients the no-show policy. 
  • Create a workflow where your staff is alerted to follow-up with patients who have missed appointments. They should advise patients why keeping appointments is vital for consistency in treatment. Of course, there should be exceptions for emergencies. Document no shows and follow calls in the patient’s file. Communication is key. 
  • Ensure scheduling systems can record no-shows. 15-minute appointments are standard for medical providers, while new patient visits could be 30-45 minutes. When no show rates or slow periods appear, book two 15 minute segments, thus allowing the remaining 30 minutes for longer appointments or new patients. 

Small practices, in particular, can be hurt by no-shows. If a practice with one physician has 45 minutes available, it may be nearly impossible to fill it on short notice. This is why providers require 24 or 48 hours’ notice for cancellation – providing time that another appointment could be scheduled and making up for lost revenue. 

The type of patients a practice has can also affect the no-show percentage. Specialists whose services are not covered by insurance or Medicaid are vulnerable to no-shows. Some practices charge a no-show fee when feasible, but that has its challenges. Medicaid does not allow a provider to bill a patient for missed appointments. If a patient is charged a no-show fee on a credit card, this is a self-pay charge and should be set up using a miscellaneous dummy code in your billing management system. 

Reminder services are available through electronic health record (EHR) systems. They can remind patients by email, text, or phone of their appointments and give them an option to confirm or reschedule if needed. It’s essential to communicate with the patient the importance of showing up and finding convenient times. 

Whatever method you use to advise patients of the consequences of no-shows, make it clear, concise, and effective communication. Train your staff accordingly on their duties in dealing with no-shows. This will assist in creating a thriving, beneficial practice for both you and your patients. 

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