Practice Management Alert

Question: Can I charge patients who fail to show up for their appointments, and how should I set that up?

California Subscriber

Answer: Unless its prohibited under your contract with an insurer, you can charge patients for missing appointments, but you cannot bill insurers for it. To charge a no-show fee, you need a policy stating when the charge will be levied, how long before the appointment patients must cancel to avoid the charge, and how much the charge will be.

You must notify patients of the policy by letter, in the practices brochure and in whatever information you give to new patients.

In your computerized billing system, make sure you dont code the no-show charge as an office visit. Instead, create a charge and develop your own code for it, and then bill the patient for that charge.

However, before you start developing a no-show fee to increase revenues, ask yourself whether you realistically are going to get paid. Patients who routinely dont keep appointments certainly are not going to pay the fee. And, if they refuse to pay the no-show charge, consider whether youre willing to spend the time and effort to send bills to collect it, and to pay to have a collection agency pursue it.

Also, charging such a fee will not promote good relationships with your patients, many of whom will interpret the bill as a way for their doctor to make money unfairly. Disgruntled patients can be devastating to a practice because they will discuss their problems with their friends, which often results in the practice losing patients or failing to attract new ones.

After examining potential collection problems and the possible negative effects on patient relations, most practices will decide against such a charge. The best way to handle patients who repeatedly miss appointments is to speak with them about the problem. Try to be accommodating, but stress that you have a cancellation policy that says, for example, appointments must be canceled 24 hours in advance. Remind them that the reason for the policy is to provide quality care and efficiently use the physicians time. Sometimes a guilt trip may work: Point out that the time slot they reserved but didnt use caused another patient to wait a day longer to see the doctor.