Patients not turning up for their scheduled appointments is certainly not a new problem, but that doesn’t mean that you have to sit back and accept a high no-show rate as a normal part of running your practice. No-Show Policy.
If your no-show rate is anywhere near the national average of 27%, you are losing tens of thousands of reimbursement dollars each year. To reduce your no-show rate, it all comes down how easy you make it for your patients to understand your policy. Sounds easy enough but getting it right can be tricky.
As you draft your no-show policy, keep the following definitions in mind:
- No-Show: Patient provides no notice and completely fails to show up to a scheduled appointment.
- Late Cancellation: Patient calls to cancel their appointment too close to the scheduled time to allow you to fill the slot.
- Late Arrival: Patient arrives at your office after the allotted time of their scheduled appointment.
Setting Your Policy Parameters No-Show Policy
The goal is to set no-show parameters that are clear and easy to understand. Taking the time to answer these questions before you begin writing your policy will help it be more effective.
- How many times can a patient no-show before being charged a penalty?
Although you want to change patient behavior, you don’t want to lose good patients because of a random event (i.e., car crash, emergency room visit, sick child, etc.). So, although you can choose to charge a fee for the first no-show, this can be perceived as unreasonable and can lead to patient loss. Instead, consider giving your patients a pass on the first and maybe the second no-show. But, if you do this, be sure to remind them that if it happens again, there will be a fee.
- How far in advance must patients cancel their appointment NOT to be considered a late cancel?
When setting the required amount of advanced notice your patients must give when canceling an appointment, consider how long it typically takes you to fill the slot. If you have a very busy practice with a waiting list, the time may be negligible. However, if you are in a rural area, it may take longer.
- How many times can a patient late cancel before you will charge a penalty?
If you are too aggressive, you could just tick off your patients. You don’t want to lose good patients due to an overly strict rule. Consider giving your patients one or two late cancels before charging them. However, if a patient does late cancel and you give them a “pass,” be sure they know it. Then remind them of your late cancel policy, including when you will charge a fee and how much it will be.
- How late past a scheduled appointment time is considered a late arrival, and will your patient still be seen?
Consider the following factors when answering this question:
- Appointment Reason: If you are seeing the patient for a quick visit (i.e., a recheck or to simply confirm a UTI on an otherwise healthy patient, etc.), you may be able to be somewhat flexible. However, if the patient is coming in for an in-office procedure that requires a more extended period of time, flexibility may not be an option.
- Schedule Capacity: If your practice schedule is jam-packed, one late patient can throw everything into chaos. In this situation, patients who late cancel will most likely not be seen and will need to make another appointment.
- Spot Filled: Obviously, if you’ve already given the appointment time to someone else, the original patient can’t have it. At this point, you should inform the patient that they’ll need to schedule another appointment.
Getting Patients to Hear You
Simply having a no-show policy and getting your patients to read it isn’t enough. You must make sure that your patients really understand the parameters and consequences of your policy. This will help avoid patient surprises and dissatisfaction. Follow the steps below to improve patient comprehension of your no-show policy.
- Get Patient Buy-in: Having your patients sign your no-show policy can help reinforce its importance. Try adding a “yes” statement to the signature block to reiterate the key points of your policy. For example:
I [ADD PATIENT NAME] agree to [ADD DOCTOR OR PRACTICE NAME]’S no-show policy as described above. I understand that I will be charged a fee of $[ADD FEE]for missing more than [ADD NUMBER] appointments within one year without canceling at least [ADD NUMBER DAYS/HOURS] in advance.
- Timing: Here are some common touchpoints for when to provide patients with your no-show policy:
- New Patients: When patients first join your practice, you should go over your policies with them. One of these should be your no-show policy.
- Beginning of Every Year: It can be helpful to have your patients resign policy documents at the beginning of each year to reiterate them. This can also be an excellent time to review and revise your policies, if necessary.
- Policy Changes: If you change your no-show policy during the year, you should have patients resign the new document at the beginning of their next appointment.
- Plain English: Keep your policy simple and to the point. The meat of the policy should be one to three paragraphs tops. Also, utilize bold and underlines to highlight the important portions of your policy.
- Verbally Explain: Taking the time to sit down with your patients to explain your no-show policy can improve compliance. Also, be sure to make it clear that payers don’t typically reimburse fees associated with late cancellations, late arrivals, and missed appointments. That means they will be responsible for paying them.
Charging No-Show Fees
It is really up to you to decide when and how much to charge your patients for late cancellations, late arrivals, and missed appointments. That is, as long as it complies with the guidelines outlined in your payer contracts. Also, whatever your no-show policy is, be sure to apply it equally to all of your patients regardless of their payer. You certainly don’t want to be hit with a discrimination lawsuit based on variations when you implement your no-show policy.
The challenge with no-show fees is that sometimes collecting them can be a challenge. One way to avoid this hassle is to get a credit card from your patient that you keep on file should they trigger a no-show fee. If you do this, there are several essential things you must keep in mind:
- Communicate usage: You must clearly spell out how and when the patient’s credit card on file will be used.
- Notification: Before you process a card that is on file, be sure to notify the patient. If you don’t, you risk the patient disputing the charge with their credit card company. At a minimum, this makes more work for you. Once a charge is disputed, the credit card company will contact you and ask that you provide proof that the patient agreed to the charge. Depending on the credit card company’s investigation on the viability of the charge will result in you either keeping the money or having it removed from your account.
- Agreement: Summarize your policy with when and how much you may charge on the card. Finally, have the patient sign to agree to the policy. Here is some sample verbiage to consider at the end of your policy:
I [PATIENT’S NAME] am permitting you to keep my credit card on file only to utilize if I fail to meet the agreed-upon terms of this policy. The maximum amount you will charge on my card will be $[ADD MAXIMIMUM AMOUNT]. I also understand that you will notify me each time before you charge my card.
Agreed to by: [PATIENT SIGNATURE LINE] Date: [SIGNED DATE]
Note: See related blog post, Set Patient No-Show Fees That Comply with Payer Contracts.
Finally, when crafting your no-show policy, try to avoid loopholes and clauses that can give your patients the ability to argue that they didn’t know about the fees. Also, being clear avoids catching a patient off guard when you charge a fee, which heads of patient dissatisfaction.
FREE TOOL: Download this document that contains two sample no-show policies to give yourself a head start on writing/drafting your no-show policy.
Before you implement your no-show policy, you must be sure it is legally compliant. For help with this, check out the online training, Patient No-Shows: Reduce Legal Risk and Lost Revenue, presented by healthcare attorney Gina L. Campanella, Esq, FACHE. During this online training, Gina will provide you with step-by-step answers that help you avoid common legal pitfalls related to no-show policies. This online training is immediately available for you to access.
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