Dealing With No-Shows, Nonpayers, and Other Office Problems

Disclosures

November 05, 2013

Why Didn't That Patient Show Up?

Dealing with no-shows, best ways to get payment from patients with high-deductible insurance plans, and what to do about disgruntled employees who post nasty comments on the Internet are some of the most common problems plaguing primary care medical offices. Practices have come up with creative solutions to these issues and shared them at the 2013 MGMA (Medical Group Management Association) conference in San Diego.

The Missing Patient: Dealing With No-Shows

Every practice wrestles with the problem of no-shows. The patient doesn't call or doesn't cancel the appointment; he or she just doesn't show up, and it leaves a gap in your scheduled day. Practices vary in how severely they treat no-shows, but more and more are charging the patient for the missed appointment and making sure to collect the payment.

Many offices have their no-show policy written into their patient consent form and also have it prominently posted within several office areas.

"We charge $25 for a no-show, and if the patient doesn't pay, we kick him out of the practice," says one. In an informal poll, almost one third of the practices present said they charge a fee for no-shows. Although $25 seemed to be the standard amount for a no-show fee, one practice charged $50.

"After the first no-show, we call the patient to check on what happened. Why did you miss the appointment? Was there some medical reason? We also let them know that if it happens again, we will have to dismiss them."

Most offices gave patients a little more leeway than kicking them out after the first infraction.

"We have a patient notification system that has worked well: We phone the patient in advance of the visit to remind them of the visit, and if we are leaving a message, we tell them they have to call back to verify and accept their appointment. If they have done so and then don't show up, we charge the patient. But if they haven't verified, we call again and talk to the patient, asking what the problem is or why they didn't show up." Some practices allowed no-show patients to make new appointments, but they had to re-earn the right to get the 'best' appointment slots.

"If they don't call to confirm, we reduce their visit allotted time to 15 minutes. That way, we have the option to fill in a slot if they don't show up. If the patient does come in, we say, 'We can only do some basic things today.' If they call for another appointment after having not shown up, we will only give them appointments at the end of the day, and we let them know that we will try to work them in to the doctors' schedule, and they may have to wait longer."

Even with a phone verification system, some patients give the excuse that "they did call and cancel, but somehow the right person at the practice simply didn't get the message." The scheduler may feel that they are lying, but it's hard or impossible to disprove their statement.

One practice installed phone tracking software so they could identify and verify calls that came in. "If we can find the call that the patient says they made to cancel, obviously we don't charge them. But if they didn't call and cancel, we charge the amount of the copay to the patient; or if the patient was scheduled to have a physical examination, we charge $50."

Most practices have a "3 strikes and you're out" policy for no-shows, although a large percentage make it "2 strikes and you're out."

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