Dec 09
8
How to Deal With Missed Appointments
A missed appointment is a business expense for a clinician for the following reasons:
- The clinician could have filled the appointment slot.
- There is a cost to the making of and canceling of appointments.
- Even if the patient doesn’t show, the clinician still needs to review the patient’s chart, to ascertain whether there was an urgent need for followup with the patient. This is work that is not reimbursed.
Charging for Missed Appointments
The American Medical Association has opined that it is ethical for physicians to charge for missed appointments, or for appointments not canceled at least 24 hours in advance, if patients are fully advised of the possibility of such charges.
Practices should develop policies regarding missed appointments, and share the written policy with new and established patients, at reasonable intervals. Communicating the policy could be part of an intake process for new patients. Established patients could be notified of the policy when checking in for appointments, or when a patient is given an appointment, the receptionist could communicate the policy orally with followup by mail. If the practice has a Web site, the policy should be published there. The policy could be posted at the desk or in the waiting room. Send a copy of the policy along with the bill, when charging the patient for the no-show. The practice may want to ask the patient to sign the statement, acknowledging the policy and accepting responsibility for a charge for a missed appointment.
The missed appointment policy should not be used to deny care to a patient who presents for a scheduled appointment. That is, if a patient missed an appointment August 1, 2009, was billed for the missed appointment, has not paid, and shows up for an appointment on September 8, 2009, do not deny care on September 8 based on failure to pay the missed appointment charge.
Crafting a reasonable charge is tricky. Consider whether the practice is charging for actual costs or for the missed opportunity to charge. If the practice filled the appointment slot at the last minute, there is no missed opportunity. A brief Internet search revealed that practices charge $20 to $50 for missed appointments.
Specifics of the Policy
Typically, no-show policies apply to a patient who does not show or cancels less than 24 hours prior to the appointment. Practices may want to write a policy to apply to patients who are more than 15 minutes late for an appointment (after 15 minutes, the patient has missed the appointment). However, if the practice or clinician chronically runs late, there could be a significant public relations downside to implementing a 15-minute policy.
Here are some suggestions regarding policies:
- Consider letting the first missed appointment go without charge. If so, make it clear in the policy that the practice “understands events can occur unexpectedly and therefore, a one-time missed appointment will not be charged.”
- Consider implementing a “three strikes you’re out,” rule and terminate patients who are chronic no-shows.
- Excuse missed appointments if the patient is admitted to a health care facility due to illness or injury.
- State that future visits may not be scheduled until the missed appointment fee is paid.
- State that payment for a missed appointment is the responsibility of the patient, cannot be billed to Medicare or other insurer, and is due upon receipt of the bill.
- State that the purpose of the policy is to protect the practice from loss of “availability” to its patient population in medical need and assist in covering daily overhead cost of providing your services to the community.
Medicare Allows Practices to Charge for Missed Appointments
Medicare allows physicians to charge patients for missed appointments, provided they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments. Medicare’s policy states that the charge for the missed appointment is not a charge for a service (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity. The amount that the practice charges must apply equally to all patients, whether Medicare or non-Medicare.
A hospital outpatient department may charge a beneficiary for a missed appointment, unless the patient is a hospital inpatient who has an appointment in the outpatient department.
Medicare won’t pay for the missed appointment. The physician or supplier must bill the patient directly. This policy appears in the Medicare Claims Processing Manual, Chapter 1, Section 30.3.13.
How to Reduce No-shows
Instituting a policy to charge patients for missed appointments may reduce the number of no shows. Here are other methods of doing so:
- Make reminder calls. The calls should be 1 to 3 days prior to the appointment.
- Follow up on recent no-shows. Call each patient who has failed to make his appointment, and ask the reason for the missed appointment. Reschedule if necessary.
- Analyze no-show statistics. Determine which types of appointments are likely to be missed and the timing of those appointments. For example, in general a patient who schedules an appointment for 4 to 7 days in the future is more likely to keep the appointment than a patient who is given an appointment the next day or who schedules far in advance.
- Keep the office running on time. Patients who routinely wait more than 15 minutes to be seen are more likely to come late or not show for appointments.
Overbooking does not decrease no-shows, but it does decrease the lost business cost of no-shows. However, overbooking can lead to long wait times for patients, which could lead to increased no-shows.
Don’t Let the No-shows Fall through the Cracks
There is also a malpractice risk associated with no-shows. If a patient has been advised to return for further evaluation, and the patient’s condition is such that a failure to treat has dire consequences, and the lack of return visit leads to a failure to treat, then the failure to keep the appointment could cause the patient a bad outcome and could subject the clinician to a lawsuit. So, if a return visit or other followup is critical, a nurse or physician should not let the patient’s issues fall through the cracks. Call the patient and advise him or her of the urgency of followup, the time line that is advised, and the worst-case scenario if followup does not occur in a timely manner. Document the advice given.
As always, much appreciation to MedScape.
