Ophthalmology and Optometry Coding Alert

Tip: Make sure your carriers don't frown on payment penalties

Every office has them -- patients who schedule an appointment and never show up. So how can you code for an office visit if the patient never shows up? Well, you can't -- but you can take steps to minimize lost reimbursement for "no-show" patients. Use these field-tested strategies on missed appointments.

Start by Contacting Patients 

Making reminder phone calls prior to appointments and follow-up calls to patients who miss an appointment are good steps toward lessening the reimbursement woes caused by no shows.

Pointer #1: Look into current technology that allows you to make automated telephone reminders. Or, if you can, collect e-mail addresses and send e-mail reminders.

Pointer #2: Many practices contact patients after they have missed two or three appointments, telling them that they will be charged a fee for another missed appointment or that they could even be dismissed from the practice.

"Our new policy is that patients are allowed three no- shows; after that, they are terminated from the practice," says Christopher Felthauser, CPC, CPC-H, ACS-OH, ACS-OR, PMCC, medical coding instructor for Orion Medical Services in Eugene, Ore.

Important: Make sure patients are aware of your policy. Putting it in writing in your new patient materials is a good way to ensure patients see the policy and post it in a prominent place in the waiting room. When his practice changed its no-show policy, Felthauser says, they updated the practice's financial policy to show the new information and notified all patients of the change.

Best practice: Have a written policy and a sheet that the patient signs and gets a copy of acknowledging they've reviewed the policy, says Quinten A. Buechner, MS, MDiv, ACS-FP/GI/PEDS, CPC, president of ProActive Consultants LLC in Cumberland, Wis. "For those very few who do not want to sign, the reception staff enters the date on the form with a note 'Patient given copy of form but would not sign.' These forms then go in the record."

In your policy, include information such as: 

• The patient will need to notify you that he is not going to show

• Whether you'll charge a fee

If you are going to charge a fee, what that fee is.

Charge for Repeat No-Shows

If a patient misses an appointment, you can charge the patient a no-show fee.

Caution: Be sure you check with your carriers to see if they have a problem with you charging a no-show fee. "We tried instituting a no-show penalty payment. However, many of your contracted insurance companies may frown on that -- especially Medicaid. Our Medicaid population seems to have the highest number of no-shows. So it really didn't do any good," Felthauser says.

Note: "Only Medicaid has a national policy saying you cannot charge the patient a no-show fee," Buechner says. "You can negotiate any restrictive clause out of a contract. That is why the no-show policy should also be tied to your policy for dismissing patients.

"You do need to look at your contracts, but if you make a no-show fee part of your financial policy, you can usually bill the patient a fee with the exception of Medicaid," Buechner says.

Be considerate: Emergencies do happen, so be sure you allow for contingencies in your no-show policy. For example, if a patient has a car accident on the way to her appointment, you certainly wouldn't want to charge for the missed appointment.

Consider the negative public-relations impact of charging a no-show fee, experts say. If you charge a patient a no-show fee, he could complain about your practice to other potential patients, and you still may never collect that fee. In addition, the cost of sending patient statements to collect that fee and follow-up collection work by your staff has an additional negative effect to your practice and will inflate your A/R unnecessarily. Patients often ignore these bills and will seek healthcare elsewhere. 

Keep Track in Patient Charts

When a patient does miss an appointment without notifying the office in advance, you should note it in the patient's file and, if possible, in your electronic patient account so that this information will show if the patient requests another appointment.

Reasoning: First, this gives you an accurate count of how many times a patient has been a no-show. Accurate documentation can help with any legal issues that arise if you end up discharging a patient from your practice.

In addition, depending on the patient's diagnosis, missed appointments might mean the patient is not compliant with his plan of care, which could represent an increased risk for malpractice liability. A log of unannounced missed appointments and attempts to contact the patient to inquire about the missed appoint-ment with an attempt to reschedule helps protect you.