There is no simple solution to this and there are multiple factors here. On one hand, asking for a credit card deposit on the phone does set a bad tone, but with high deductibles and co-payments and tight schedules, last minute cancellations are also unfair to other patients who would otherwise been able to obtain care sooner.
I agree that calling the patient the day before to confirm is far better than collecting a credit card "deposit" on the potential new patient. However the reality is that tight schedules and last minute (24 hours is last minute) cancellations are unfair to other patients who also have tight schedules and may need to be put off. Patients need to understand that their appointment is secured by the "hold" placed on their credit card.
And this does not only apply to new patients as some established patients are also chronic no shows despite using the day or two before reminder services which allow patients to confirm or cancel their appointments.
Another issue is that collecting cancellation fees prior to the appointment may be contrary to your contract with the carrier. Thus it is important to be sure that no charges go the carrier prior to the appointment and that patients sign an agreement that they understand this payment is based on an agreement between the two parties and will somehow either be totally refunded or credited to outstanding balances when the patient is seen.
Perhaps a better idea would be to email, fax or have the patient go to your website and have them complete all the new patient documents and sending them back to you sometime prior to their appointment (more than 24 hours). Having them complete these forms will save your staff time at the first office visit. On one of your forms you can also include a payment sheet which provides a credit card to facilitate collection of co payments and/or charges subject to any deductibles or cancellation fees. Some patients may prefer to pay with other means (your demographics will easily predict this), some preferring debit cards others EFT transfer from their bank, etc.
It's also important to make patients understand that your office policy is not to see patients unless their obligations (co pays, deductibles, etc.) are paid prior to their visit. To suggest that this sets a bad tone is not reality. New (and even established) patients often ask how their co-payments can be made. With co payments sometimes more than the actual allowance for the service (I've seen some for $75) and patients whose insurance doesn't kick in until their $12K deductible has kicked in, it's more important than ever that patients are properly educated.
By putting the cancellation fees last, you minimize the feelings of payment prior to the visit.
Again this is a complex subject and I don't really believe there is a right or wrong previously presented. There should be a gentle way to communicate these issues to your patients. Your practice demographics should enable you to find that comfortable approach.
Paul Kesselman, DPM, Woodside NY
Other messages in this thread:
04/19/2017 Keith Gurnick, DPM
Missed First Appointments (Frank J. DiPalma, DPM)
No matter how efficiently you try to run your office scheduling, and no matter how well trained, courteous and professional your office staff is on the scheduling phone calls, and no matter if you e-mail, text, or make reminder phones call one or even two days in advance of the appointment, there will always be a some no shows (some without even the courtesy of a cancellation phone call), or same day or last minute cancellations , some with a request to be rescheduled for that same initial visit during that same phone call.
New patients, just like existing patient Cancellations and no-shows happen for a variety of reasons, some of which have already been listed in other posts. The reasons are not relevant anyway.
Here is my office policy:
1) We do not require a credit card up front to schedule a NP appointment, unless it is a cash patient with no health insurance and then we do. A cash patient who will not give us the credit card info on the phone is simply not scheduled, simple as that.
2) Every new patient, even if scheduled for the same day receives an e-mail from my office which includes the office policy and a bunch of other things we want the patient to have access to on their cell phone (such as location, parking, insurance, office policy, etc.)
3) We allow one no show or one new patient cancellation with no repercussions or financial punishments.
4) The 2nd time there is a no show or cancellation the patient is required to give us their credit card, in order to reschedule again, and the card is charged $150 which is non- refundable for any reason. That is $75 to pay for both (two) of the prior no-shows, or previous last minute cancellations. A last minute cancellation is any appointment that is cancelled within 24 hours, but also only if we were not able to reallocate to another new patient who wants to get in asap.
Here are my results: 1/2 the time we get the credit card, we charge the $150 and when we reschedule the patient they finally show up the next time (usually on time also.) Often, these patients continue to be "scheduling flakes" for follow up appointments.
The other 1/2, do not want to pay or give the credit card over the phone, thus they also do not want to commit to their next appointment and we never see them or hear from them again. I assume they go somewhere else and become someone else's issue.
However, rather than my office staff telling a potential new patient who either no showed or cancelled twice, that we won't see them, or that we will not reschedule them, it is better to let the patient make their own decision: if they want to become a patient in my office or not.
Keith Gurnick, DPM, Los Angeles, CA
04/18/2017 Lynn Homisak
Missed First Appointments (Frank J. DiPalma, DPM)
I believe you are asking ‘should you bill a new patient you haven’t even seen yet?’ and ‘should you collect their credit card information prior to their appointment? Instead of applying a Band- aid on an obvious problem and sending a negative message to patients before you even meet them, why not try to determine the reason WHY new patient cancellations are such an issue for you?
Yes, new patients must occasionally cancel an appointment. It happens. It is not typical, however, to have a new patient cancellation "problem". Unless of course, new patients are scheduled so far out that their ailment went away or they decided to go see `Doctor Downthestreet’ and get that plantar fascia fixed sooner. Maybe they had a poor phone experience or your office location/appearance didn’t appeal to them? Just as you would do clinically…address the symptoms, diagnose, and then treat the problem.
Ideally, new patients should be scheduled within one to three days of calling your office, unless they specifically request a later time. Courtesy reminder calls are beneficial as is keeping a "Wait List", allowing your staff to reschedule any empty blocks of time as they occur. You can certainly create a more mindful behavior by explaining the practice's “no-show” fee policy at their first visit, but do you really want to penalize new patients before you have a chance to prove that you are exactly what they are searching for in a podiatrist? Show them you're glad they called you by getting them in – sooner, rather than later. If that is indeed the problem, it’s likely that your no-show rate will improve and everyone wins.
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