Dermatology Coding Alert

Question: Recently we have had a lot of patients showing up late for appointments. The physicians do not want us to cancel appointments and turn patients away when they are late, but this habit is starting to wreak havoc on our scheduling and other patients are getting upset because the provider gets behind. Plus, office staff and nurses are getting frustrated with having to stay later and later because of late patients. How can we handle this, short of telling the physicians they can’t see patients who are late?

Tennessee Subscriber

Answer: Every practice has patients who show up late. Sometimes it is unavoidable due to inclement weather or an accident on their travel route that caused a traffic backup. Other times it is just a patient who isn’t good about showing up on time. Regardless of the reason, late patients can throw a wrench in your practice flow.

As you mentioned, you can always turn patients away and consider them no shows if there are late. But this can lead to upset patients and loss of revenue because you are cancelling provider work.

From the sound of it, your practice follows an individual time-slot type of scheduling where you schedule patients whenever there is an opening or an open access schedule, where time slots are left open for patients to call in and make day-of appointments.

One alternative that many practices find works is rather than having individual timeslots throughout the day that you schedule patients in, you use a block scheduling method. With this process, you schedule several patients for a certain block of time and the provider sees the patients in the order they arrive. This way you can attempt to compensate for patients that show up late. For example, if your physician can see three established patients or two new patients in 45 minutes, you can schedule three existing patients or two new patients in each 45 minute block in the schedule and tell the patients they will be seen in the order they arrive.

Example: Using block scheduling, you schedule three patients to come in at 8:00 am to see Physician A. Patient 1 arrives at 7:55; patient 2 arrives at 8:05; and patient 3 runs into rush hour traffic and doesn’t arrive until 8:15. Your medical assistant can take patient 1 back shortly after she arrives, and the provider will likely see her by 8:00. Patient two will be seen shortly after arriving and patient 3, who was latest will be seen last. If you had scheduled patient 3 for an individual 8:00 am timeslot, your provider would be 15 minutes behind schedule right from the start of the day.