Pediatric Coding Alert

Question: During the snow storm last week, 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?

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.