Oncology & Hematology Coding Alert

Find a balance between business strategy and patient goodwill.

In the last issue we discussed how to set a fair fee and bill for no-shows. No-shows are inevitable, but you can work with patients to minimize the incidence of no-shows.  

Inform Your Patients

You should tell all of your patients about the policy and have them sign the policy with their other annual financial documents. The purpose of a no-show policy is to notify your patients of a possible financial penalty for failure to cancel a scheduled appointment in a reasonable amount of time prior to the appointment (excluding medical emergencies). It is good to have the policy reviewed by legal counsel to make sure it doesn’t infringe on a patient’s rights in any way from how it’s written, says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc. “This should only be intended on misses due to poor time management/planning and not if there are other care concerns prohibiting them from being seen.”

You need a written policy that includes information such as:

• If the patient needs to notify you that he is not going to show, and how long before the appointment you expect to be notified.
  
• Whether you’ll charge a fee, and how much that fee will be.
  

Example: Your policy could state something such as “Failure to give 24-hour notice of cancellation of an appointment or not presenting to the office for a previously scheduled appointment can result in a charge of $25.00 on your account. This charge is non-covered by your insurance company and would be considered your responsibility. Failure to pay a no-show fee will be treated the same as our policy on unpaid patient balances and will be subject to reporting to a collection agency if unpaid.”

“Ideally, the no-show policy should be incorporated in the practice’s financial policy and requires a patient signature agreeing to the policy,” says Charlene Endre-Burgett, MS, CMA (AAMA), CPC, CMSCS, administrator for North Scottsdale Family Medicine in Ariz.

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.

“If you’re clear from the start as to what the expectations are of the patient, it’s helpful to have a contract with them,” says Leslie Johnson, CPC, manager of coding, compliance & education at Somnia, Inc. in New Rochelle, NY. “Whether a sign on the wall at sign-in, or a verbal reminder from the person setting the appointment, or a written form to be signed, it can help people know that how they behave as a patient can affect others at this same practice. This not only should include missed appointments but people who are habitually late.”

Try to Stop No-Shows Before They Happen

Sending reminder notices or making appointment reminder phone calls can help alleviate some of your missed appointment concerns. Check to see if your electronic record systems will generate automatic phone or secure message via your patient portal with a detailed reminder 48 hours before the appointment.” with an email to send the patient to the patient portal’s secure messaging inbox.

“A well-placed reminder, such as the day/night before an appointment can help to make sure that patients come in at the right time,” Johnson explains. “It’s also a good idea because the patients feel like the physician really does care about who they are and about their health.”

Down side: 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. Make sure your oncologists are on board with your policy and that the policy balances patient goodwill with good business strategy.

Be understanding: Not every missed appointment is the result of a poorly behaving patient. Emergencies, such as car accidents, emergency medical care needs or unexpected hospital admissions, do happen, so you need be somewhat flexible. If a patient misses an appointment because she is in the emergency room for themselves or with their child, for example, you probably shouldn’t charge the fee.

“A location in a city-like environment might find that patients may be challenged looking for open parking spaces,” Johnson says. “Look to see if the patient(s) is a chronic offender or if there’s a good reason. Bad things happen to good people, and if a patient is generally always on time and doesn’t show or is considerably late due to a pressing situation, it may not be good practice to penalize them for the no-show. When creating a policy, all these things should be considered.”  

“Lastly, confer with the office or clinic’s legal counsel to verify the policy does not infringe on patient’s rights or other state laws regarding patient access to healthcare as it is written and can be confidently enforced,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc.