RE: Charging For Missed Appointments (Debbie
Leverton)
From: Michael Z. Metzger, DPM, MBA, Barry
Mullen, DPM
As far as verifying appointments with phone
calls, I would suggest two days in advance. In
that way the patient have the "in between day"
to call and cancel or reschedule if they need to.
Michael Z. Metzger, DPM, MBA
Lewisville, TX
Are missed appointments occurring only
within a small select group of patients? Is
there a consistent pattern of no shows without
prior cancellation notification in this group?
If so, I suggest the following approach; have
your office manager or receptionist contact
those patient(s) to learn why their appointment
was missed. In some cases, there may be
coincidental, legitimate explanation(s).
Regardless of excuse, have your staff
empathetically explain why it is imperative for
all patients to notify your office, in as much
advance as possible, when they cannot keep their
appointment. Explain that this courtesy has
become an office policy because it ultimately
benefits patients in two major ways. 1)
Prompt appointment cancellation notification
creates opportunities for your staff to fill
vacant appointment time(s) for others who
require your services. It's quite possible there
may come a time where they, themselves, will
benefit from scheduling a same day appointment
whose time slot was created through that same
courtesy. If the problem continues and becomes a
pattern (3 times), send a certified letter,
return receipt requested, that due to a
consistent pattern of missed appointments
without prior cancellation notification, this
non-compliance with your office's policy
prevents you from scheduling future appointments
for them short term. Place the patient
on "probation" by only allowing them to see the
doctor as a "walk-in". Explain how your staff
will try to filter them into the doctor's
existing schedule as soon as he(she) becomes
available. Explain that this may, unfortunately,
entail a wait, since the doctor always extends
the courtesy of honoring those patients with
scheduled appointments first.
That is the second way in which the patient
ultimately benefits since the effects is they
now know they will be seen in a timely fashion.
Reasonable patients should respect and adhere to
this policy. Once a patient loses the
opportunity to schedule future appointments, if
they were happy with the service(s) you provided
in the first place, they will be more apt to
comply with your office policy in the future.
Barry Mullen, DPM
Hackettsown, NJ
RE: Charging for Missed Appointments (Debbie
Leverton)
We don't charge for missed appointments at
my office. My dentist does and I find it
obnoxious. A better approach is to call each
patient 24 hours prior to a visit to confirm. If
a patient consistently does not show up, ask
why? Perhaps there is a legitimate reason. If
not, explain to the patient that you allocate
time for each patient and there are costs
associated with your office time. If the patient
still cannot be responsible you might wish to
discuss alternative options for podiatric care
with that patient.
Elliot Udell, DPM
Hicksville, NY
Query: Charging For Missed Appointments
We are having trouble with patients that
make appointments, and do not show up for them.
My question is, if we put up a sign stating that
if the patient does not give 24 hours notice,
our office will charge for missed appointments,
are there any rules that say we can or can not
charge a fee for appointments that are missed?
Debbie Leverton
Fridley, MN
Codingline Responses:
There is no prohibition against charging
for 'no-shows.' For Medicare, of course, you
cannot submit a claim, but must charge the
patient directly. Since this is not a covered
service, no advance beneficiary notice (ABN) is
required.
Fred Wolfe, CPA
Huntington, WV
Before you do anything else, I would
strongly urge you to check your managed care
contracts and state law for limitations and
rules. Typically, the practice of stating a '24-
hour notice to cancel appointments or there will
be a charge' has long been accepted in medical
practices. The difficulty is in the collecting
of the fee. If hit with a demand for such a fee,
the patient might just elect to go to another
doctor.
One doctor in Dallas, TX once suggested making
appointments like hotel reservations: "What
credit card would like to guarantee that
appointment with? You can cancel the appointment
with a 24-hour notice, otherwise your card will
be charged..." The doctor noted that at least
that way you have a mechanism to collect the
money.
In our practice, we do not do that. We do,
however, confirm appointments the day before
with a phone call. This has been successful in
decreasing the missed appointments (typically
the 'no show' patient) significantly. When we
investigate why the patient did not keep their
appointment, most times the response is that
they forgot. Reminding them 24-48 hours before
does work to reduce those 'no-shows'.
Don Blum, DPM, JD
Dallas, TX
We believe that it is appropriate to charge
for missed appointments as long as you allow
patients to charge your office for lateness or
missed appointments!
Obviously if a patient is frequently negligent,
he or she should be dismissed from your
practice. Otherwise, we are all human and
sometimes forget about appointments or have
emergencies arise.
The best strategy for avoiding missed
appointments if to call the patient the day
before to confirm the appointment. HIPAA rules
apply when doing this.
Barry Block, DPM, JD
Forest Hills, NY
