Collect your lost reimbursement while remaining compliant. When missed appointments happen, your practice needs to offset the cost since every dollar and every minute count. You can start collecting a fee for no-show appointments, so your practice avoids a significant reimbursement loss. Just keep in mind that flexibility is the key, as every missed appointment is not willful. Emergencies happen. Follow these four expert tips to ensure you are implementing a solid plan that will offset your losses. 1. Decide If a No-Show Fee Works for Your Practice The purpose of a no-show policy is to notify your patients of a possible financial penalty for failure to cancel a scheduled appointment. Missed appointments have an impact on the physician's schedule or the physician's availability to other patients, and can also pose a health risk to the patient. No-show appointments cost the practice real dollars, experts say. But deciding what to do about it depends on your providers, your practice, and your location. In some cases, charging patients a fee when they miss a visit will help your practice offset the lost time and money the open appointment time cost. But in some cases, charging patients a no-show fee could have a negative impact on your patient relations and could result in negative public relations for your practice. "In a large metropolitan area where there is a lot of competition, this can just upset patients who will then share with their friends and family," says Charlene Endre-Burgett, MS, CMA (AAMA), CPM-MCS, CPC, CMSCS, administrator with North Scottsdale Family Medicine in Ariz. "That kind of bad PR can harm the practice. However, there are cases when this would be an excellent way to deter 'no-shows' and works well. I don't think there is a right or wrong way to solve this universal problem; whatever works for each office is the best way." 2. Beware of Payer Policies Your first step in evaluating whether to charge a fee to patients who do not show up for appointments is to check with your payers. Read the details of your contract or contact your payer rep to see what limitations you may have on billing the patient. Your contract may give you scenarios of when you can, and can't, bill for a no-show. For example, most payers will not allow you to charge a patient who cancelled her appointment more than 24 hours before the scheduled appointment time. Pointer: "I would always suggest that each office check their insurance contracts to verify," says Endre-Burgett. "The only payer that I am aware of [that doesn't allow charging a no-show fee] would be Medicaid. Medicare allows charging for no-shows as long as it is the office policy and done universally to all patients (except Medicaid)." Key: 3. Fine-Tune Your Policy Once you decide to implement a no-show policy, your practice needs to decide how the process will work. Most practices allow patients one or two "freebies," meaning that they excuse the first missed appointment and do not charge a fee. You should send a letter to the patient, however, reminding him of your practice's policy on no shows. Once you've sent a letter reminding the patient of the policy, you should consider charging a fee for additional missed appointments. Then, if the patient begins to consistently schedule and no-show, you have the right to discharge him as a patient after a few offenses. "As far as how the no-show policy is set up will depend on the philosophy of the physicians/practice," says Endre-Burgett. "Some may provide a first written warning, assess a fee at the second offense, and discharge the patient if it happens a third time. Another policy would be to have a fine for the first no-show increasing incrementally for the second and third." Don't limit your policy to just in-office appointments either, experts suggest. If your providers perform procedures or surgeries, consider charging no-show fees for those as well. "Perhaps even have a patient provide a down payment that is non-refundable," Endre-Burgett suggests. "That down payment can be the patient's responsibility determined by checking the benefit with their health plan." Set your fee: Be proactive: Make exceptions: 4. Implement a Written Policy Once your practice develops a no-show process and you are going to start charging for no-shows, you need a written policy that includes information such as: Example: Ask your patients to sign and date the form when they first join your practice, as they would do when they initially sign your privacy or financial policies. You can incorporate the no-show policy into your financial policy, Cobuzzi explains.