Charging for missed appointments
By Marty Kotlar, DC, CHCC, CBCS

What can I do about patients who miss their appointments? Missed appointments affect clinical results and impose a financial burden on my practice. My staff wants to charge a “missed appointment fee.” Can I do this?

Missed appointments cost a practice in three different ways — lost revenue (from the missed treatment), staff time (spent in making follow-up calls and rescheduling), and empty time (which could have been filled with another patient).

Most practices allot 45 minutes to 60 minutes for a new patient. If a patient misses that appointment, the doctor could have seen anywhere from three to 10 people for chiropractic care during that time.

With lost revenue adding up, more practices are beginning to charge for missed appointments. Telling patients you’ll charge for a missed appointment gets them to come in. It can also help your practice recoup some of its lost revenue, if the patient indeed pays the bill.

Many practices simply threaten to charge for missed appointments to get patients through the door. Or, they issue a warning and waive the fee for the first missed appointment.

The American Medical Association (AMA) policy states a physician may charge a patient for a missed appointment or for one not cancelled 24 hours in advance, if the patient is fully advised the physician will make such a charge. Charging a patient for a missed appointment could be intended for those who really abuse the system.

No CPT code exists for missed appointments.

Charging for missed appointments has its advantages and disadvantages. On the plus side, your no-show rate may go down and you might gain some revenue from the missed appointments.

But on the negative side, you run the risk of alienating some patients who may abdicate your practice for that of another doctor.

Charging patients also adds overhead to your practice. Even if you are vigilant in sending out your bills, many charges may go unpaid. Also, the targets of missed appointment charges most often are the busy professionals who are well insured — the type of patient a practice generally doesn’t want to lose.

OTHER ALTERNATIVES

Instead of charging a no-show fee, consider implementing proactive alternatives to addressing no-shows, including tracking them to learn who are the chronic cases, and scheduling these individuals near the lunch hour or at the end of the day.

• Phone first. Though it’s tedious work, many practices use some form of a telephone reminder system to confirm upcoming appointments with patients.

This simple action step is the most effective way to keep no-shows to a minimum. It’s also the only way to deal with new patients, who typically require longer blocks of time. New patients are the hardest to gauge, since the office does not have a history with them.

• Double-book appointments. This solution, like charging no-shows, has advantages and disadvantages:

You can be assured of filling virtually every slot, regardless of the no-show rate; more patients means more revenue. But if all of your patients show up, you are bound to fall far behind your schedule. And double-booking does not fix the problem of missed appointments.

• Make reminder calls and use waiting lists. Some offices keep waiting lists of patients who have an appointment several weeks out, but would like to see the doctor sooner. Waiting lists can help fill more slots at the last minute, especially if a practice takes careful notes and knows which patients are willing to do anything to get an earlier appointment.

This method allows you to get in touch with patients shortly before their appointment, and if they can’t make it, you can refer to your waiting list to fill the slot quickly. This is a personal touch to which patients respond.

But, a lot of staff time is spent leaving messages during business hours, and you can never be sure the patient received the message.

• Use an automated phone system. To avoid tying up staff hours in making calls, many offices have started to invest in automated calling systems, which also can interface with practice management software to conduct the entire appointment-confirmation process with very little, if any, human input.

Automated systems can also make calls later in the evenings, when the chance of reaching a live voice is better, and they allow for an immediate confirmation. Automated call systems could be a critical practice tool.

However, they may also be expensive to implement and confusing for staff. Patients might not like the automated aspect of it.

Marty Kotlar, DC, CHCC, CBCS, is the president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, by e-mail at drkotlar@targetcoding.com, or through the Web site, www.targetcoding.com.