Dermatology Coding Alert

Question: We have a few patients who routinely miss appointments or show up late. We'd like to emphasize the importance of keeping appointments without alienating the patients. Can we bill for no-show visits and/or charge a fee for being late?

Illinois Subscriber

Answer: Whether you can bill for no-show visits or charge a late fee will depend on your payer contracts and the laws in your state. Some contracts, such as Medicaid, prohibit no-show charges or fees unrelated to patient services. Check your contract and state laws, and if allowed, you may bill the patient for this inconvenience.

Many practices charge a fee (such as $25) for missed appointments, but there are other options to consider:

• If a patient is chronically late, tell them an earlier appointment time than what you schedule. For example, tell the patient her appointment is at 9:30 a.m., but actually schedule it for 10 a.m.
• If you charge for missed appointments or a certain number of late arrivals, post that information so patients are aware of the policy. Include notices on the registration form, in the registration area, and in the waiting room. Some practices write off the first occurrence and consider it part of patient education.
• Have a financial policy that mentions the fee in writing.
• Have the patient sign a copy of the policy, which he keeps, plus one you will keep with his chart. That way he cannot claim he was never told or did not see the notification.
• Tell late arrivals that your staff will fit them in as best you can, but that patients who are on time for appointments get preference. Give the patient the option of rescheduling a time.
• If the patient misses an appointment, send a follow-up letter. Set a guideline for yourself and send a stronger letter each time until you reach the predetermined point of dismissing the patient.

Examining how your practice handles this issue is a good opportunity to address scheduling and other issues from an internal perspective. If you're in a larger multispecialty clinic, realize that parking or registration might be affecting your patients. Also take a look at how you schedule sick visits.

Many will be "no shows" if you book them a day or two ahead because the patient improves and the parent does think to cancel the appointment. And finally, use this opportunity to encourage your physicians to be on time. Some parents assume that if the doctor is running late, it won't matter or won't be noticed if they're late for the scheduled time.