Internal Medicine Coding Alert

Question:  We’ve had a lot of patients showing up late for their appointments recently for various reasons. The physicians don’t want us to cancel appointments and turn patients away when they’re late, but it really throws our schedule off and upsets other patients when the provider gets behind. Plus, office staff and nurses are getting frustrated with having to stay later in the day to treat the 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, being late is unavoidable because of inclement weather, accidents, or traffic backups. Other times, the patient simply 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 they’re late. But this can lead to dissatisfied patients and loss of revenue because you’re cancelling physician work at the last minute. 

It sounds like 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 using a block scheduling method rather than having individual timeslots throughout the day in which to schedule patients. With this process, you schedule several patients for a certain block of time, and the physician sees the patients in the order they arrive. This way, you can attempt to compensate for patients who 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 a.m. to see Physician A. Patient 1 arrives at 7:50; 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 physician will likely see her by 8:00. Patient 2 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 physician would be 15 minutes behind schedule right from the start of the day.