Orthopedic Coding Alert

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 ensure your office recovers some reimbursement for time lost? Use these field-tested strategies to collect on missed appointments. Start by Contacting Patients  Making reminder phone calls prior to appointments and making 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 will allow you to make automated telephone reminders. Or, if you can, collect e-mail addresses and send e-mail reminders.

Pointer #2: Many practices contact a patient after he has missed two or three appointments, telling him that he will be charged a fee for another missed appointment or that he 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. 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 into the record.-

In your policy, include information such as: 

- The patient needs 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 [...]