What do you do when a patient misses an appointment? While an opening in the schedule might seem like a good time for staff to take a break or catch up on their to-do lists, missed appointments are a growing problem in physician practices. With today’s need to maximize every dollar, practices should take a closer look at the effect these missed appointments have on their bottom lines.
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Explore This IssueJanuary 2008
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Missed appointments should not be taken lightly; there is a price for no-shows and last minute cancellations. In addition to affecting efficiency, failure to manage this area of a practice can result in staggering associated costs. For example, if the average E/M charge for a patient with rheumatoid arthritis is $100 and there are five no-shows each week, the lost revenue could be $26,000 a year or more.
Effective October 1, 2007, healthcare professionals can bill Medicare beneficiaries directly for missed appointments. Medicare guidelines state that physicians must bill and charge the same amount to non-Medicare patients for missed appointments. The policy states that, “the charge for a missed appointment should reflect an amount indicative of a missed business opportunity and should not be a charge for the service itself (to which the assignment and limiting charge provisions apply).” Note that Medicare does not reimburse for missed appointment fees and charges, so providers should bill patients directly.
The CMS policy allows charges to Medicare beneficiaries for missed appointments if:
- The practice does not discriminate against Medicare beneficiaries;
- The charge amount is the same for all patients;
- The practice does not submit charges or bill Medicare; and
- The charge for a missed appointment is presented to the beneficiary.
If your office doesn’t have a policy in place regarding missed appointments and no-show patients, now is a good time to establish one. When developing this type of policy:
- Establish your practice protocol in writing;
- Communicate the new policy to all patients by posting signs in high-traffic areas such as waiting rooms and check-in and check-out stations; and
- When processing or updating patient information forms, provide a copy of the practice policy outlining no-show charges.
A missed appointment limits practices from providing care to patients. This also negatively impacts practice operations, as it is a missed business opportunity that could cover increasing operational costs.
Here are points to consider when creating a policy that protects the practice, while at the same time is sensitive to maintaining positive patient relationships.
- Provide a window of opportunity for the cancellation of a visit. Typically, 24 hours is a reasonable expectation.
- Let the first one go. Give yourself the flexibility to not charge for the first missed appointment. You can do that by making it clear in the policy that the practice “understands events can occur unexpectedly and therefore a one-time missed appointment will not be charged.”
- Excuse missed appointments in the event the patient is admitted to another healthcare facility due to illness or injury.
- Establish clearly that payment for a missed appointment is the responsibility of the patient and is due upon receipt of charge.
- Keep in mind that medical care cannot be denied to a patient who arrives for a scheduled appointment and has not paid a previous missed appointment charge.
- Define in your policy that future visits may not be scheduled until the missed appointment fee is paid.
Details regarding charges for missed appointments are available on the CMS Web site, www.cms.hhs.gov.