Eli's Rehab Report

Warning: Make sure your payers don't frown on payment penalties

Every office has them -- patients who schedule an appointment and never show up. But you can take steps to minimize lost reimbursement for "no-show" patients.

Step 1: Take Preventive Measures First

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: 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.

Warn up-front: Create a policy that tells patients they will be responsible for a fee after they miss several appointments, or that you could even dismiss them 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.

Another way: "In 2007 for our cash pay services, especially for sports science, we are going to start asking for the credit-card number of the patient prior to their first visit for bike fits, physiology testing, and gait analysis," says Jason Amrich, PT, CSCS, clinic manager for Boulder Center For Sports Medicine -- East in Louisville, Colo. His policy reads that the practice will charge patients 50 percent of the anticipated charge if they miss their appointments.

Key: Whatever your policy is, make sure you put it in writing. Post it in a prominent place in the waiting room, or even better, have the patient sign the policy, acknowledging he has reviewed it, 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, be sure to mention these three key elements: 1) that the patient will need to notify you that he is not going to show, 2) whether you'll charge a fee, and 3) if you are going to charge a fee, what that fee is.

Step 2: Charge for Repeat No-Shows -- With Care
 
If a patient misses an appointment, follow through with your policy. "Currently we charge no-shows $50 for a missed appointment," Amrich says. "We leave the discretion to charge up to the therapist but have set a firm rule that only one no-show should be tolerated."

Critical: Be sure you check with your carriers to see if they have a problem with your charging a no-show fee. "Many of your contracted insurance companies may frown on instituting a no-show penalty payment -- especially Medicaid," Felthauser says.

"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."

Remember to be considerate as well because emergencies do happen. So 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.

Considerations: Get a feel for the negative public- relations impact of charging a no-show fee as well, 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 on your practice and will inflate your accounts receivable unnecessarily. Patients often ignore these bills and will seek healthcare elsewhere. 

Finally, be sure to keep good records of missed appointments. This will not only help you keep track of  when to charge late fees, but also the documentation can help if any legal issues arise when you discharge a patient from your practice.