Cruel to Be Kind
One of the things I hate is when we're forced to charge for patient no-shows. There was no firm policy regarding this when I started working at my current practice, and after a spate of cancellations early in my tenure, I finally put my foot down.
We established a rule that notice must be given within 24 hours of the visit. Also, everyone would be charged a nominal fee regardless of coverage. Signs were posted prominently in the waiting area. When out receptionist called patients with friendly reminders, she also mentioned the policy.
As a general rule, we've always allowed for the rare, solid excuses (when they are offered), and every patient is allowed one time to abuse the policy. After that, however, we do charge them a no-show fee after more than one missed appointment, and even though it seems harsh, I feel it's a worthwhile policy. It reminds them that while we are in the business of healthcare, we are a business, and there is a financial impact for their failure to arrive as scheduled.
What about your office? Do you have a policy regarding no-shows? Do you charge patients for missed appointments? As usual, I'm interested to hear your perspective.
posted by Anne @ 8:43 AM
10 comments
10 Comments:
The majority of the patients seen out here in Southern CA are HMO patients. 9 out of 10 plans do not allow to charge for missed appointments and if a charge is colleced and the patient calls the plan to complain,the patient must be reimbursed. However, if it is documented that the patient has missed 3 or more appointments, the office can request the health plan to assign the member to another phyician in the area.
We also charge a fee, but it is graduated and is higher for longer appointments. We notify patients of the charge both when scheduling and confirming.
That being said, we're pretty liberal about waiving fees. If patients call at least two hours in advance, then we generally feel we can reuse the slot. Also, we'll accept some excuses that are provided after the fact.
For people who have multiple no-shows, we may ask them to find a new practice.
Exactly as yours is - allowing one waived fee within any 12 month period. We go further. We mail a letter that states the $25 fee. Billing company is also aware of it. If patient does not show multiple times, then we do not manage the patient any longer and mail them a letter of such (with 1 month of care provided till they can find another provider). If patient becomes abrasive, I tell them it is not in my hands. It is the office policy (yes, i make it) and I remind them there are still office expenses incurred to keep a patient slot. Also, if they want dedicated time with their provider, they should be responsible to come. Otherwise, all slots can be double booked!
TCB
We recently instituted a policy for no shows or cancels with less than 24 hour notice. We charge a flat $75.00 fee. We have had some patients complain and refuse to sign our financial agreement. We do not reschedule their appts until they sign the agreement. When we have had these issues I look into the patients appointment history and surprise...they have no showed or cancelled last minute multiple times!! I think that it helps weed out the people who abuse the priviledge of seeing one of our physicians.
After 3 no-show or late cancel appointments, we do charge, but generally patients do not pay. They must pay before being seen, but generally do not return after 3 no-shows. We do discharge patients for multiple no-show appointments.
Our physicians schedules are so packed and overbooked, they look forward to a few "No Shows"
Interesting comments. I have to wonder about the whole "priviledge to see one of our physicians" comment. Perhaps the patient is thinking that it's a privilegde for the physician to be seeing him/her as a patient.
For all those practices who charge a patient a "no-show" fee, do you think it would be unreasonable for the patient to charge the physician a "late-fee" for not showing up to the appointment "on-time"? Or, would the physician reimburse a patient for a "no-show" fee he/she received from another provider that they might have been scheduled to see after the first one, but missed it because the first doc was "running behind".
I understand no-shows can be a frustration, but that's a part of your business. If you have a high no-show rate your business practices need to be reviewed.
Do people take surveys as to why people are no-showing. Is it because they had to wait weeks for an appointment and were able to get in somewhere else and just forgot about it. Do offices with high no-show rates make reminder calls?
Can you imagine the local five star restaurant sending you a bill for not showing up for a reservation... or hair saloon... etc. Seems like everyone is trying to get something for nothing.
If you have repeat offenders than guess what... STOP GIVING THEM APPOINTMENTS... :)
Keeping It Real -
I would love it if the Dr.'s here had to pay for being late. Here if you are 5 min late they can cancel you BUT if they are 20 min late to see you, you are just supposed to shut up and take it.
Our office charges $40 for a No Show that doesn't give 24 hours notice. However, we do listen to reasonable excuses and check patients history of last minute cancellations. I feel strange asking for the money when several of our doctors run late. What to do?
We do not charge for no shows for regular doctor visits but we do charge for no shows for Mammogram appointments.
The logic is that we do double book some doctor visit slots, thus if a few patients do not show up it is not going to burst the bank.
However, we feel charging for Mammogram appointment no shows is legit as (a) they are not double booked, so if a patient is a no show the mammo tech ( high dollar employee) and the mammo equipment (high dollar overhead) are both idle !! (b) secondly, mammogram appointments have long lead time due to shortage of mmx facilities and thus wasting a "slot" is ethically wrong when other women are waiting for 2 to 3 months to get that mmx slot !! Thus a $25.00 charge is justifiabe.
Collecting these charges is a whole different matter !!
However, once the policy was place our Mammogram no shows have reduced drastically.
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