Ophthalmology and Optometry Coding Alert

Question: During the snow storm earlier this year, we had several patients call in and say they wouldn’t be coming to their appointments because their driveways were too icy to drive. These patients had all signed our financial policy, which clearly indicates that they are subject to a $30 charge for cancellations without 24 hours’ notice. I was planning to add this $30 charge to all of their accounts, but our office manager says we should not. What is the policy on this type of situation?

South Carolina Subscriber

Answer: There is no cut-and-dried policy on how to determine whether to bill for a no-show appointment. Even if you had the patient’s guardians sign the policy, that doesn’t mean you’ll necessarily bill them every time they miss, even though your policy entitles you to do so.

Most practices allow patients one or two “freebies,” meaning that they excuse the first missed appointment and do not charge a fee. But as your example notes, not every missed appointment is the result of a poorly behaving patient. Emergencies, such as car accidents, do happen, so you need be somewhat flexible, especially during periods when snow and ice are on the road. As a good public relations practice, you may want to waive your no show fees during this period when people are safer staying home than driving to your office.

Keep in mind: Even if your contract allows you to bill for no-show visits, that doesn’t mean you should bill the no-show fee to the payer, because they don’t cover it as a benefit. You need to bill the patient your previously decided-upon no-show fee for the missed appointment.  

And in this case, are they really “no-shows” who didn’t show up without a valid reason and didn’t inform the office in advance? No, this is really not the case and you should dig down deeper to define when an actual “no show” policy should be enforced. These patients called the office with a very valid reason for not only their own safety but also for the safety of others in deciding it best not to drive under adverse weather conditions. It could cause bad feelings and bad press to charge the $30 in these types of situations. A true “no show” is when the patient makes the appointment and doesn’t show up. 

Regardless of your “24 hour” time constraint, it just isn’t always possible to know at least 24 hours in advance that you will be sick, in an accident or have some other unexpected emergency at the last minute. It happens to all of us.