Fees & Patients

Some practices have tried asking patients to sign contract agreements limiting them to a certain amount of missed visits or be dropped from the practice. Others charge a fee for missed visits. These approaches may have some psychological value, but experts say they have mixed results. “Very few payers allow no-show fees,” says Colangelo. If your practice decides to penalize no-shows with a fee, you must apply the rule to all patients — not just those on Medicare or Medicaid — and bill the patient directly. CMS allows practices to charge no-show fees, but you must bill the patient; Medicare will reject a claim for a no-show fee. If you do charge Medicare patients for missed visits, keep in mind that you must charge all patients the same no-show fee.

Even if Medicare accepted the claim and those fees might help recoup some of the losses, charging for missed visits might be bad PR. “It’s important to realize that you’re running a business here,” says Colangelo. “It’s a personal decision how you walk that fine line between good business practice and customer service,” she points out. This creates a dilemma: you want to hold patients accountable without irritating them.

At Lorton Station Family Medicine in Lorton, Virginia, Office Manager Karla Peeger has a diplomatic way of handling no-show fees. “When a patient misses a visit without cancelling, I call the patient to make sure they are okay,” says Pfleeger. “I then advise them that we will waive the no-show fee as a first-time courtesy, but future appointments will require a 24-hour cancellation or the patient may be charged a $50 or $100 fee depending on the appointment type.” A similar approach worked for Richard Honaker, when he headed up a 13-physician practice near Dallas. His practice would produce an invoice for the missed visit with the charge marked “cancelled.” Honaker says, “This lets the patient know that they got off this time, but might not be so lucky next time.”

Whatever you decide about no-show fees, it’s important to have a specific policy and make that policy clear to your patients. But when it comes down to it, the best way to reduce no-shows is to build and nurture the relationship with your patients.