Medical Practice Question: To Charge, or Not to Charge for No-shows

A question that I am often asked is whether or not there should be charge for no-shows. In most cases this creates bad vibes with patients and creates a lot of work on the back end with little results. A blanket response to a provider complaining at a board meeting about the fact that there are a lot of no-shows is not appropriate.

What is your percentage of no-shows per week? I am not aware of a good benchmark but in talking with practices, the goal of less than 3% seems reasonable.

Instead the root cause of no-shows should be considered. Here are a few questions that should be asked when the issue of no shows comes up:

• Is it one provider? 
• Is it one day of the week or time of that day? 
• Is it one payer type? 
• Is it one age group? 
• Is it new patients? 
• How long from the call to the appointment? 
• Is it established patients? 
• Repeat offenders that can and should be dealt with individually? 
• Others in your practice? 

The main point of this is that the administrator should have sufficient data in place to offer a well thought out plan. A blanket response implies unawareness, laziness, or reactionary decision making. This type of action often times causes more problems than offers solutions.

This does not mean that a no-show charge is not warranted, it may well be for certain patients, e.g., a behavioral health patient that has difficulty with responsibility may learn something from having to pay for that a mistake.

We may have done such a good job training our patients that we always run late that they can come in late or maybe not bother to show up since they are feeling better.

We may have a provider that needs help with bed side manner and efficiency.

We may have a scheduling issue and schema and protocols needs to be changed as a result of the analysis of data.

I am sure you can find many more reasons, come up with solid solutions and develop a well thought out transition plan to address those solutions!

It’s Not Just to Provider

Another experience, simple treatment in office for poison ivy – my nemesis! Called my PCP and was told he could not see me but there is a new mid-level provider available later that day if it would be OK to see her. Of course that would be fine. The experience was typical – arrive at the office, hand over the credit card, wait 20 minutes and then escorted to the exam room. Treatment was as expected, a steroid shot, prescription and on my way home.

About a month later we receive a statement indicating we owed ~$190 for a level 4 office visit and that the insurance company had denied payment due to provider not part of the network. We called, staff indicated they  were aware and that the claim would be re-billed under that doctors name since credentialing had not been completed for the new mid-level. They would also look into the documentation for the appropriate level of care, they know that I am a consultant and understand the process.