Optometry Coding & Billing Alert

Reminder calls, no-show fees and good documentation can help

Patients who don't show up for their appointments can wreak havoc with the day's schedule, not to mention waste valuable time.

"Most offices have somewhat of a tolerance level," agrees Victoria Jackson, executive director and owner of OMNI Management Inc., California member of Medical Group Management Association, Primary Care Assembly, and administrator/CEO of Southern Orange County Pediatric Associates Inc. in Lake Forest, Calif. "Most of us have a two-strike rule," she says. If patients do not show up for two scheduled visits, they are warned: Should they fail to keep a third scheduled visit, they will be charged for the appointment. This usually does the trick.

Need a Reminder?

Everyone agrees that the best approach to cutting down on missed appointments is a reminder call ahead of time. Because many offices are reluctant to deter patients by charging for missed appointments, the focus is instead on rounding up negligent patients and helping them keep to the schedule.

"We do confirmation calls two days in advance," says Christine E., biller at Jordan Family Eyecare in Rochester, N.H. If you can't get in touch with the patient directly, leaving a message usually works well.
 
A phone call to follow up after a missed visit is a good idea as well. Rescheduling the appointment can sometimes solve the problem. If a patient does not respond to telephone messages, a letter may be in order. Many practices have a standard letter signed by the doctor, which is sent out to patients after they miss a second appointment.

Another Solution: Charge a No-Show Fee

If a patient doesn't show for his appointment, "we send out a letter for a no-show fee - a flat fee of $35," says Christine E. The fee doesn't actually get charged to the patient's account unless he comes into the office for another visit. "Most of the time that discourages no-show patients from coming back," she says. And this can help you prevent wasted time in the future.

Good excuses allowed: If a patient does want to schedule another visit and he has a good reason for missing his last scheduled appointment, "we're pretty lenient about waiving the fee," says Christine E. As long as the no-show was a one-time occurrence and isn't something the patient has done three times previously, she adds. Keeping track of no-shows will allow you to determine quickly whether a patient is a repeat offender.

Why Keep Track?

Keeping track of no-shows is not just about tracking them down. You can easily spot serial no-show patients when charts are kept up-to-date. When a patient with a history of no-shows calls to make an appointment, you will be able to identify this problem and tell the patient that it can't happen again.

"We actually document [no-shows] in the medical record as well as in our computer system," Christine E. says. This helps to identify past no-show patients, as well as patients who have never missed an appointment. If a long-time patient doesn't present for a scheduled appointment, her chart will tell you this has never happened before, and you can call to make sure she's OK  and that there wasn't a scheduling mistake within your system, she says.